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Predictors of metabolic syndrome in Asian north Indians with newly detected type 2 diabetes
Reprint requests: Prof. Anil Bhansali, Head, Department of Endocrinology, Postgraduate Institute of Medical Education & Research Chandigarh 160 012, India e-mail: anilbhansali_endocrine@rediffmail.com
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Received: ,
Abstract
Background & objectives:
The identification of metabolic syndrome (MS) among patients with type 2 diabetes (T2DM) is of great importance, since those with MS carry a cluster of cardiovascular risk factors. This study evaluates suitable criteria with high efficiency in diagnosing MS and to identify the strongest predictors of MS in newly detected type 2 diabetes individuals.
Methods:
Newly detected type 2 diabetes (<6 months) patients were assessed. The MS was assessed by WHO, National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), modified NCEP-ATP-III and International Diabetes Federation (IDF) criteria. Receiver operating characteristics (ROC) curves of serum triglycerides, HDL, and waist circumference were created for the prediction of MS and the area under the corresponding curves (AUC) were used to evaluate the predictive efficiency of each MS parameter. Different cut points in the selected variables and the corresponding sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were estimated.
Results:
Among the 563 newly detected T2DM individuals, the presence of MS ranged from 57 to 68 per cent according to the different criteria. The higher percentage of MS was observed in modified NCEPATP III criteria. In comparison to men, presence of MS was higher in women in all the four criteria [198 (67%) vs. 165 (62%); 209 (70%) vs. 111 (42%); 231 (78%) vs. 151 (57%); 222 (75%) vs. 129 (49%)] by modified WHO, NCEP-ATP III, modified NCEP-ATP III, and IDF, respectively. The predictive ability to diagnose MS was highest with modified NCEP-ATP III and lowest with IDF criteria. The optimal cut-off of waist circumference in men and women were 90 and 88 cm respectively. Serum triglyceride in men effectively indicated the presence of MS in newly detected T2DM individuals, whereas, in women the HDL-C was the stronger predictor of MS.
Interpretation & conclusions:
The study results show that modified NCEP-ATP III criteria predict highest occurrence of MS in newly detected T2DM patients. Elevated serum triglyceride for men and decreased serum HDL-C in women were the strongest single predictors, effectively indicating presence of MS in newly detected T2DM.
