Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Grupo de Investigación en Diabetes, Obesidad y Reproducción Humana. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
Endocrine. 2022 Jun;76(3):601-611. doi: 10.1007/s12020-022-03041-8. Epub 2022 Mar 28.
We aimed to determine, in patients with type 1 diabetes (T1DM), the impact of excluding hyperglycemia as a criterion from the International Diabetes Federation (IDF) definition of the metabolic syndrome (MetS), both on its prevalence and on its association with micro and macrovascular complications and markers of subclinical inflammation.
A cross-sectional design, including 280 patients with T1DM. We defined MetS by three different models: (i) the standard IDF criteria, (ii) a modification consisting of excluding of hyperglycemia as a criterion (modified IDF criteria) and (iii) a modification consisting in changing the hyperglycemia by insulin resistance (MetS + IR model) defined by the estimated glucose disposal rate. Microvascular complications and cardioautonomic neuropathy were assessed. We measured an inflammatory panel including high sensitivity C reactive protein, erythrocyte sedimentation rate, homocysteine, and fibrinogen concentrations.
After excluding hyperglycemia, the prevalence of MetS was 6.4% (95%CI: 4.1 to 9.9) compared with 20.7% (95%CI: 16.3 to 25.8) using standard IDF criteria. After adjusting for duration of diabetes, all three MetS definitions increased the odds for having microvascular complications [OR: 6.012 (2.208-16.307) for modified definition; OR: 5.176 (2.555-10.486) for standard definition and [OR: 3.374 (1.649-8.456) for MetS+IR model]. However, the both modified IDF models for MetS showed better predictive performance than standard criteria for suffering from neuropathy, nephropathy, cardiovascular disease and were associated with markers of subclinical inflammation.
The prevalence of MetS significantly varies as a function whether or not hyperglycemia is included as a diagnostic criterion. The subset of patients fulfilling the modified MetS definitions may reflect better the concept of metabolic syndrome in T1DM. These modified definitions were accompanied by a poorer metabolic control and lipid profile, showing the worse inflammatory biomarker profiles and higher odds for micro- and macrovascular complications. In patients with T1DM, the inclusion of insulin resistance instead of hyperglycemia as a criterion of MetS may be of interest in routine clinical practice.
本研究旨在探讨在 1 型糖尿病（T1DM）患者中，将国际糖尿病联盟（IDF）代谢综合征（MetS）定义中的高血糖排除作为一个标准，对 MetS 的患病率及其与微血管和大血管并发症以及亚临床炎症标志物的相关性的影响。
本研究采用横断面设计，纳入了 280 例 T1DM 患者。我们使用三种不同的模型来定义 MetS：（i）标准 IDF 标准；（ii）一种排除高血糖作为标准的修改模型（修改 IDF 标准）；（iii）一种通过估计葡萄糖清除率来改变高血糖的模型（MetS+IR 模型）。评估微血管并发症和心脏自主神经病变。我们测量了包括高敏 C 反应蛋白、红细胞沉降率、同型半胱氨酸和纤维蛋白原浓度在内的炎症标志物。
排除高血糖后，MetS 的患病率为 6.4%（95%CI：4.1%至 9.9%），而使用标准 IDF 标准时为 20.7%（95%CI：16.3%至 25.8%）。调整糖尿病病程后，所有三种 MetS 定义都增加了微血管并发症的发生几率[修正定义的比值比（OR）：6.012（2.208-16.307）；标准定义的 OR：5.176（2.555-10.486）；MetS+IR 模型的 OR：3.374（1.649-8.456）]。然而，MetS 的两种修改 IDF 模型在预测神经病变、肾病、心血管疾病方面均优于标准标准，并且与亚临床炎症标志物相关。
MetS 的患病率随高血糖是否作为诊断标准而显著变化。符合修正 MetS 定义的患者亚组可能更能反映 T1DM 代谢综合征的概念。这些修改后的定义与较差的代谢控制和血脂谱相关，炎症生物标志物谱较差，微血管和大血管并发症的发生几率更高。在 T1DM 患者中，将胰岛素抵抗而非高血糖作为 MetS 的标准可能在常规临床实践中具有意义。
