The metabolic syndrome as predictor of type 2 diabetes: the San Antonio heart study
- PMID: 14578254
- DOI: 10.2337/diacare.26.11.3153
The metabolic syndrome as predictor of type 2 diabetes: the San Antonio heart study
Abstract
Objective: The oral glucose tolerance test identifies high-risk subjects for diabetes, but it is costly and inconvenient. To find better predictors of type 2 diabetes, we evaluated two different definitions of the metabolic syndrome because insulin resistance, which is commonly associated with this clustering of metabolic factors, frequently precedes the onset of type 2 diabetes.
Research design and methods: We compared the ability of the National Cholesterol Education Program (NCEP) definition, a modified version of the 1999 World Health Organization (WHO) definition that excludes the 2-h glucose requirement, and impaired glucose tolerance (IGT) to predict incident type 2 diabetes. In the San Antonio Heart Study, 1734 participants completed a 7- to 8-year follow-up examination.
Results: IGT and the NCEP definition had higher sensitivity than the modified WHO definition (51.9, 52.8, and 42.8%, respectively). IGT had a higher positive predictive value than the NCEP and modified WHO definitions (43.0, 30.8, and 30.4%, respectively). The combination of the IGT and NCEP definitions increased the sensitivity to 70.8% with an acceptable positive predictive value of 29.7%. Risk for incidence of type 2 diabetes using the NCEP definition was independent of other risk factors, including IGT and fasting insulin (odds ratio 3.30, 95% CI 2.27-4.80). The NCEP definition performed better with fasting glucose >or=5.4 mmol/l (sensitivity 62.0% and positive predictive value 30.9%).
Conclusions: The metabolic syndrome predicts diabetes independently of other factors. However, the NCEP definition performs better than the modified 1999 WHO definition. Lowering the fasting glucose cutoff to 5.4 mmol/l improves the prediction of diabetes by the metabolic syndrome.
Comment in
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The coming of age of the metabolic syndrome.Diabetes Care. 2003 Nov;26(11):3180-1. doi: 10.2337/diacare.26.11.3180. Diabetes Care. 2003. PMID: 14578259 Review. No abstract available.
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An update on diagnostic criteria for diabetes and the metabolic syndrome.Rev Cardiovasc Med. 2004 Summer;5(3):182-5. Rev Cardiovasc Med. 2004. PMID: 15346103 No abstract available.
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