Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
Letters: Comments and Responses

The Metabolic Syndrome: The Emperor Needs Some Consistent Clothes

Response to Vinicor and Bowman

  1. Charles M. Alexander, MD
  1. From Outcomes Research & Management, Merck & Co., West Point, Pennsylvania
  1. Address correspondence to Charles M. Alexander, MD, Outcomes Research & Management, Merck & Co., P.O. Box 4, WP39-170, Sumneytown Pike and Broad Streets, West Point, PA 19486. E-mail: charles_alexander{at}merck.com
Diabetes Care 2004 May; 27(5): 1244-1244. https://doi.org/10.2337/diacare.27.5.1244
PreviousNext
  • Article
  • Info & Metrics
  • PDF
Loading

Response to Vinicor and Bowman

Drs. Vinicor and Bowman (1) point to a number of challenges associated with formalizing medical syndromes for clinical and public health purposes in this issue of Diabetes Care. I agree with the issues they raise; it is not yet clear whether the metabolic syndrome is a separate syndrome or simply a collection of commonly recognized cardiovascular risk factors. The current working definitions provide a useful means for clinicians to identify high-risk patients and manage them accordingly. Researchers can use the criteria to readily identify patients with the syndrome and enhance our understanding of the basic pathophysiology and management. Although the vigorous and systematic evaluation of proposed criteria for the metabolic syndrome is necessary and valuable, we need to keep the criteria simple and clinically relevant. An example of the use of an original set of criteria that was later elucidated by further research is the case of rheumatic fever. The original definition of rheumatic fever, the Jones criteria, was based on the occurrence of specific manifestations (2). We now know that evidence of recent group A streptococcal infection (positive throat culture or elevated antistreptolysin O or other streptococcal antibody titers) is much more important than whether any of the specific manifestations is present. There may also be a limit to what can be gained by perfecting the current working definition of metabolic syndrome. Rather, progress with regard to the metabolic syndrome will more likely come from an improved understanding of its pathophysiology. With regard to the metabolic syndrome and insulin resistance, important research (3–14) has recently appeared in the medical literature that may provide important clues to help substantially improve our understanding. While there is no doubt that this research will generate as many new questions as answers, available criteria to identify individuals with metabolic syndrome serve to appropriately focus our attention and facilitate future progress to benefit our patients.

Footnotes

  • DIABETES CARE

References

  1. ↵
    Vinicor F, Bowman B: The metabolic syndrome: the emperor needs some consistent clothes (Letter). Diabetes Care 27:1243, 2004
    OpenUrlFREE Full Text
  2. ↵
    Jones TD: The diagnosis of rheumatic fever. JAMA 126:481–484, 1944
    OpenUrlCrossRef
  3. ↵
    Unger RH: Lipid overload and overflow: metabolic trauma and the metabolic syndrome. Trends Endocrinol Metab 14:398–403, 2003
    OpenUrlCrossRefPubMedWeb of Science
  4. Unger RH: The physiology of cellular liporegulation. Annu Rev Physiol 65:333–347, 2003
    OpenUrlCrossRefPubMedWeb of Science
  5. Schaffer JE: Lipotoxicity: when tissues overeat. Curr Opin Lipidol 14:281–287, 2003
    OpenUrlCrossRefPubMedWeb of Science
  6. Andrews RC, Herlihy O, Livingstone DE, Andrew R, Walker BR: Abnormal cortisol metabolism and tissue sensitivity to cortisol in patients with glucose intolerance. J Clin Endocrinol Metab 87:5587–5593, 2002
    OpenUrlCrossRefPubMedWeb of Science
  7. Masuzaki H, Paterson J, Shinyama H, Morton NM, Mullins JJ, Seckl JR, Flier JS: A transgenic model of visceral obesity and the metabolic syndrome. Science 294:2166–2170, 2001
    OpenUrlAbstract/FREE Full Text
  8. Morton NM, Holmes MC, Fievet C, Staels B, Tailleux A, Mullins JJ, Seckl JR: Improved lipid and lipoprotein profile, hepatic insulin sensitivity, and glucose tolerance in 11beta-hydroxysteroid dehydrogenase type 1 null mice. J Biol Chem 276:41293–41300, 2001
    OpenUrlAbstract/FREE Full Text
  9. Petersen KF, Befroy D, Dufour S, Dziura J, Ariyan C, Rothman DL, DiPietro L, Cline GW, Shulman GI: Mitochondrial dysfunction in the elderly: possible role in insulin resistance. Science 300:1140–1142, 2003
    OpenUrlAbstract/FREE Full Text
  10. Kelley DE, He J, Menshikova EV, Ritov VB: Dysfunction of mitochondria in human skeletal muscle in type 2 diabetes. Diabetes 51:2944–2950,
  11. Enns GM: The contribution of mitochondria to common disorders. Mol Genet Metab 80:11–26, 2003
    OpenUrlCrossRefPubMedWeb of Science
  12. Short KR, Vittone JL, Bigelow ML, Proctor DN, Rizza RA, Coenen-Schimke JM, Nair KS: Impact of aerobic exercise training on age-related changes in insulin sensitivity and muscle oxidative capacity. Diabetes 52:1888–1896,
  13. Leverve XM, Guigas B, Detaille D, Batandier C, Koceir EA, Chauvin C, Fontaine E, Wiernsperger NF: Mitochondrial metabolism and type-2 diabetes: a specific target of metformin. Diabetes Metab 29:6S88–6S94, 2003
  14. ↵
    Petersen KF, Dufour S, Befroy D, Garcia R, Shulman GI: Impaired mitochondrial activity in the insulin-resistant offspring of patients with type 2 diabetes. N Engl J Med 350:664–671, 2004
    OpenUrlCrossRefPubMedWeb of Science
PreviousNext
Back to top
Diabetes Care: 27 (5)

In this Issue

May 2004, 27(5)
  • Table of Contents
  • About the Cover
  • Index by Author
Sign up to receive current issue alerts
View Selected Citations (0)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Diabetes Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
The Metabolic Syndrome: The Emperor Needs Some Consistent Clothes
(Your Name) has forwarded a page to you from Diabetes Care
(Your Name) thought you would like to see this page from the Diabetes Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
The Metabolic Syndrome: The Emperor Needs Some Consistent Clothes
Charles M. Alexander
Diabetes Care May 2004, 27 (5) 1244; DOI: 10.2337/diacare.27.5.1244

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Add to Selected Citations
Share

The Metabolic Syndrome: The Emperor Needs Some Consistent Clothes
Charles M. Alexander
Diabetes Care May 2004, 27 (5) 1244; DOI: 10.2337/diacare.27.5.1244
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Primary Aldosteronism in Diabetic Subjects With Resistant Hypertension
  • Primary Aldosteronism in Diabetic Subjects With Resistant Hypertension
  • Flexible Intensive Insulin Therapy in Adults With Type 1 Diabetes and High Risk for Severe Hypoglycemia and Diabetic Ketoacidosis
Show more Letters: Comments and Responses

Similar Articles

Navigate

  • Current Issue
  • Standards of Care Guidelines
  • Online Ahead of Print
  • Archives
  • Submit
  • Subscribe
  • Email Alerts
  • RSS Feeds

More Information

  • About the Journal
  • Instructions for Authors
  • Journal Policies
  • Reprints and Permissions
  • Advertising
  • Privacy Policy: ADA Journals
  • Copyright Notice/Public Access Policy
  • Contact Us

Other ADA Resources

  • Diabetes
  • Clinical Diabetes
  • Diabetes Spectrum
  • Scientific Sessions Abstracts
  • Standards of Medical Care in Diabetes
  • BMJ Open - Diabetes Research & Care
  • Professional Books
  • Diabetes Forecast

 

  • DiabetesJournals.org
  • Diabetes Core Update
  • ADA's DiabetesPro
  • ADA Member Directory
  • Diabetes.org

© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.