Dhanaraj Ethiraj, Bhansali Anil, Jaggi Shallu, Dutta Pinaki, Jain Shikha, Tiwari Pramil, Ramarao Poduri
Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education & Research, Mohali, Punjab, India.
Indian J Med Res. 2009 May;129(5):506-14.
BACKGROUND & OBJECTIVE: 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.
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.
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 & CONCLUSION: 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.
2型糖尿病（T2DM）患者中代谢综合征（MS）的识别非常重要，因为患有MS的患者存在一系列心血管危险因素。本研究评估在新诊断的2型糖尿病个体中高效诊断MS的合适标准，并确定MS的最强预测因素。
对新诊断的2型糖尿病（<6个月）患者进行评估。采用世界卫生组织（WHO）、美国国家胆固醇教育计划成人治疗小组第三次报告（NCEP-ATP III）、改良的NCEP-ATP-III以及国际糖尿病联盟（IDF）的标准评估MS。绘制血清甘油三酯、高密度脂蛋白（HDL）和腰围的受试者工作特征（ROC）曲线以预测MS，并使用相应曲线下面积（AUC）评估每个MS参数的预测效率。估计所选变量的不同切点以及相应的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
在563例新诊断的T2DM个体中，根据不同标准，MS的发生率在57%至68%之间。改良的NCEPATP III标准下MS的发生率较高。与男性相比，在所有四种标准下女性MS的发生率更高[分别为198例（67%）对165例（62%）；209例（70%）对111例（42%）；231例（78%）对151例（57%）；222例（75%）对129例（49%）]，分别采用改良的WHO、NCEP-ATP III、改良的NCEP-ATP III和IDF标准。改良的NCEP-ATP III标准诊断MS的预测能力最高，IDF标准最低。男性和女性腰围的最佳切点分别为90 cm和88 cm。男性血清甘油三酯能有效表明新诊断的T2DM个体中MS的存在，而在女性中，HDL-C是MS更强的预测因素。
研究结果表明，改良的NCEP-ATP III标准预测新诊断的T2DM患者中MS的发生率最高。男性血清甘油三酯升高和女性血清HDL-C降低是最强的单一预测因素，能有效表明新诊断的T2DM个体中MS的存在。
