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Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes

The Metabolic Syndrome as Predictor of Type 2 Diabetes

The San Antonio Heart Study

  1. Carlos Lorenzo, MD,
  2. Mayor Okoloise, MS,
  3. Ken Williams, MS,
  4. Michael P. Stern, MD and
  5. Steven M. Haffner, MD
  1. Division of Clinical Epidemiology, University of Texas Health Science Center, San Antonio, Texas
  1. Address correspondence and reprint requests to Carlos Lorenzo, MD, Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78284-7873. E-mail: lorenzo{at}uthscsa.edu
Diabetes Care 2003 Nov; 26(11): 3153-3159. https://doi.org/10.2337/diacare.26.11.3153
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  • Figure 1—
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    Figure 1—

    Incident diabetes at the 7- to 8-year follow-up visit after stratification by age, sex, ethnicity, and BMI. A: Incident diabetes by age category (P for trend <0.0001). B: Age-adjusted incident diabetes by sex (P = 0.352) and ethnic group (P < 0.0001). C: Incident diabetes by BMI category (P for trend <0.0001). D: Incident diabetes by quartiles of fasting insulin (P for trend <0.0001).

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    Figure 2—

    Diabetes risk associated with IGT or the metabolic syndrome after stratification by baseline age or BMI. A: Diabetes risk by age categories in subjects with IGT (P for trend = 0.676), the NECP definition (P for trend = 0.650), or the modified WHO definition (P for trend = 0.076). B: Age- and sex-adjusted incident diabetes in subjects initially categorized by quartiles of BMI who had IGT (P for the trend = 0.002). C: Age- and sex-adjusted incident diabetes in participants initially categorized by quartiles of BMI that fulfill the NCEP definition (P for trend = 0.006). D: Age- and sex-adjusted incident diabetes by IGT and the NCEP definition.

  • Figure 3—
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    Figure 3—

    ROC curves for the prediction of type 2 diabetes.

Tables

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  • Table 1—

    Age- and sex-adjusted baseline characteristics by incident type 2 diabetes at follow-up

    No diabetesIncident type 2 diabetesP
    n1,539195—
    Age (years)*42.7 ± 0.2747.7 ± 0.77<0.0001
    Male (%)*42.839.00.363
    Mexican Americans (%)*64.180.5<0.0001
    Family history of diabetes (%)*30.345.6<0.0001
    BMI (kg/m2)27.2 ± 0.1331.3 ± 0.38<0.0001
    Waist circumference (cm)
     Men94.2 ± 0.40101.2 ± 1.18<0.0001
     Women84.8 ± 0.4696.4 ± 1.26<0.0001
    Fasting glucose (mmol/l)4.70 ± 0.015.27 ± 0.04<0.0001
    2-h glucose (mmol/l)5.58 ± 0.047.61 ± 0.12<0.0001
    HDL cholesterol (mmol/l)1.24 ± 0.011.05 ± 0.02<0.0001
    Total cholesterol (mmol/l)5.07 ± 0.025.06 ± 0.070.828
    Triglycerides (mmol/l)1.50 ± 0.032.19 ± 0.08<0.0001
    SBP (mmHg)117.5 ± 0.35123.6 ± 0.98<0.0001
    DBP (mmHg)71.5 ± 0.2274.8 ± 0.64<0.0001
    Fasting insulin (μU/ml)12.2 ± 0.3522.3 ± 0.98<0.0001
    IGT (%)7.444.9<0.0001
    IFG (%)1.07.4<0.0001
    NCEP definition (%)14.448.7<0.0001
    Modified WHO definition (%)12.541.3<0.0001
    • Data are means ± SE.

    • ↵* Not adjusted for age and sex. DBP, diastolic blood pressure; SBP, systolic blood pressure.

  • Table 2—

    Sensitivity, specificity, and predicted values of IGT and the metabolic syndrome for identifying subjects at risk for type 2 diabetes

    SensitivitySpecificityPositive predictive valueNegative predictive value
    IGT (2-h glucose ≥7.8 mmol/l in nondiabetic subjects)51.991.543.093.9
    IFG (fasting glucose ≥6.1 mmol/l in nondiabetic subjects)9.298.951.489.6
    NCEP definition52.884.930.893.4
    Modified WHO definition42.887.230.492.1
    NCEP definition and/or IGT70.879.129.795.6
    Modified WHO definition and/or IGT66.380.930.794.9
    Fasting plasma glucose requirement changed to ≥5.4 mmol/l
     Fasting glucose ≥5.4 mmol/l42.691.739.392.6
     NCEP definition with fasting glucose ≥5.4 mmol/l*62.082.430.994.5
     Modified WHO definition with fasting glucose ≥5.4 mmol/l†49.585.430.692.9
     NCEP definition and/or a fasting glucose ≥5.4 mmol/l69.779.029.795.3
     Modified WHO definition and/or a fasting glucose ≥5.4 mmol/l60.381.129.394.0
    • ↵* The NCEP definition with fasting glucose ≥5.4 mmol/l required at least three of the following: increased waist circumference (>102 cm in men and >88 cm in women), high triglycerides (≥1.7 mmol/l), low HDL cholesterol (<1.04 mmol/l in men and <1.29 mmol/l in women), high blood pressure (≥130/85 mmHg or treated for hypertension), and fasting plasma glucose (≥5.4 mmol/l);

    • ↵† modified WHO definition with fasting glucose ≥5.4 mmol/l required fasting plasma glucose ≥5.4 mmol/l or hyperinsulinemia (fasting insulin in the top quartile of the nondiabetic population) plus at least two of the following: obesity (BMI ≥30 kg/m2 or waist-to-hip ratio >0.9 in men and >0.85 in women), dyslipidemia (HDL cholesterol <0.9 mmol/l in men and <1.0 mmol/l in women or triglycerides ≥1.7 mmol/l), and hypertension (≥140/90 mmHg or treated for hypertension).

  • Table 3—

    Multiple logistic regression analysis of incident diabetes with age, sex, family history of diabetes, NCEP definition, IGT, and fasting insulin as independent covariates

    OR95% CIOR95% CIOR95% CIOR95% CI
    NCEP definition (yes vs. no)6.304.60–8.635.544.01–7.663.772.63–5.393.302.27–4.80
    Age (× 10-year interval)——1.391.20–1.621.251.06–1.481.281.08–1.51
    Sex (men vs. women)——0.870.62–1.200.990.69–1.420.930.64–1.33
    Mexican American vs. non-Hispanic white——1.981.33–2.941.661.08–2.551.651.07–2.57
    Family history of diabetes (yes vs. no)——1.681.21–2.341.741.21–2.491.771.23–2.54
    IGT (yes vs. no)————7.004.84–10.16.374.37–9.28
    Fasting insulin (× 10-μU/ml interval)——————1.371.19–1.58
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The Metabolic Syndrome as Predictor of Type 2 Diabetes
Carlos Lorenzo, Mayor Okoloise, Ken Williams, Michael P. Stern, Steven M. Haffner
Diabetes Care Nov 2003, 26 (11) 3153-3159; DOI: 10.2337/diacare.26.11.3153

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The Metabolic Syndrome as Predictor of Type 2 Diabetes
Carlos Lorenzo, Mayor Okoloise, Ken Williams, Michael P. Stern, Steven M. Haffner
Diabetes Care Nov 2003, 26 (11) 3153-3159; DOI: 10.2337/diacare.26.11.3153
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