[Metabolic syndrome, resistance to insulin and diabetes. What is hidden beneath the tip of the iceberg?]

[Evaluation and control of hypertensive diabetics seen in Primary Care centres in Spain. BRAND II study]

OBJECTIVE

We aimed to verify the level of blood pressure and glucose control and treatment in hypertensive diabetics seen in Primary Care Centres in Spain.

DESIGN

Descriptive study conducted on hypertensive diabetic patients who attended primary care centres for any reason.

LOCATION

Primary Care centres throughout Spain.

PARTICIPANTS

The study included 6,777 patients.

MEASUREMENTS

Blood pressure, weight, height, waist circumference, blood analysis and treatment were recorded

RESULTS

The mean age of the sample was 64.40 (11.50) years. Mean blood glucose was 141.8 (39) mg/dl, glycosylated haemoglobin was ≤7% in 45.9% of the sample, and blood pressure was under control (BP≤130/80 mmHg) in 9.8% of the patients studied. LDL Cholesterol was ≤100mg/dl in 25.3% of the sample. The drugs most used to control diabetes were; sulphonylureas 2259 patients (33.3%) and biguanides 3768 patients (55.6%). A total of 556 patients were on treatment with insulin, which represented 8.2% of the population studied. The drugs most used for hypertension were; diuretics in 3395 patients (50.1%) and angiotensin-converting enzyme inhibitors in 4053 patients (59.8%).

CONCLUSIONS

A large proportion of hypertensive diabetics are insufficiently controlled.

Metabolic syndrome as a cardiovascular disease risk factor: patients evaluated in primary care

To estimate the prevalence of metabolic syndrome (MS) in a population receiving attention in primary care centers (PCC) we selected a random cohort of ostensibly normal subjects from the registers of 5 basic-health area (BHA) PCC. Diagnosis of MS was with the WHO, NCEP and IDF criteria. Variables recorded were: socio-demographic data, CVD risk factors including lipids, obesity, diabetes, blood pressure and smoking habit and a glucose tolerance test outcome. Of the 720 individuals selected (age 60.3 +/- 11.5 years), 431 were female, 352 hypertensive, 142 diabetic, 233 pre-diabetic, 285 obese, 209 dyslipemic and 106 smokers. CVD risk according to the Framingham and REGICOR calculation was 13.8 +/- 10% and 8.8 +/- 9.8%, respectively. Using the WHO, NCEP and IDF criteria, MS was diagnosed in 166, 210 and 252 subjects, respectively and the relative risk of CVD complications in MS subjects was 2.56. Logistic regression analysis indicated that the MS components (WHO set), the MS components (IDF set) and the female gender had an increased odds ratio for CVD of 3.48 (95CI%: 2.26-5.37), 2.28 (95%CI: 1.84-4.90) and 2.26 (95%CI: 1.48-3.47), respectively. We conclude that MS and concomitant CVD risk is high in ostensibly normal population attending primary care clinics, and this would necessarily impinge on resource allocation in primary care.

[Correlation between the various measurements of obesity and the degree of resistance to insulin]

OBJECTIVE

To determine the correlation between certain obesity measurements and insulin resistance (measured by HOMA).

DESIGN

Descriptive cross-sectional study.

SETTING

Urban health centre with elderly population.

PARTICIPANTS

A random sample of 70 people was chosen from among an adult population with risk factors for DM2 or already diagnosed.

MAIN MEASUREMENTS

Parameters of obesity were collected (weight, BMI, body perimeters, waist/hip index, and cutaneous folds), as were clinical parameters (blood pressure and cardiovascular risk), and analyses (glycaemia and insulinaemia--both basal and after 2 hours of oral overload of glucose--, HOMA, lipid profile, and microalbuminuria study). Resistance to insulin (IR) was defined as a HOMA > or =3.8.

RESULTS

Individuals with IR had significantly higher values of weight (85.5 vs 75.5 kg), BMI (35.1 vs 29.4 kg/m2), waist perimeter (108 vs 100.3 cm) than those without IR. In neither group were any significant differences as to the waist/hip index found. The BMI and/or waist perimeter values that were more likely to suffer IR were established. In men, the values were waist >107 cm (sensitivity, 43%; specificity, 62%) and BMI>29 (sensitivity, 57%; specificity, 50%). In women, they were a waist >102 cm (sensitivity, 64%; specificity, 89%) and BMI>34 (sensitivity, 91%; specificity, 89%).

CONCLUSIONS

In clinical practice the BMI and the diameter of the waist are very good predictors of IR, whilst the waist/hip index and cutaneous folds do not provide any information of value.

[The Framingham function overestimates stroke risk for diabetes and metabolic syndrome among Spanish population]

OBJECTIVE

To estimate stroke risk for diabetes, isolated or associated to metabolic syndrome (MS) according WHO and National Cholesterol Education Program (NCEP) criteria.

DESIGN

Multicentre and prospective cohort study.

SETTING

Primary health care.

PARTICIPANTS

Subjects between 55-85 years-old without any evidence of stroke, included from 1998 in a random population sample for MS follow-up during routine practice in Reus (Tarragona, Spain).

MAIN MEASUREMENTS

Stroke risk was achieved using Framingham function by means of a computerized algorithm using a diagnostic factorial design (diabetes and/or MS). Theoretical stroke risk and cumulated incidence of stroke events (1998-2003) were compared.

RESULTS

Among 728 subjects (412 women, mean age =66 years old, body mass index =29 kg/m2), 457 (62.8%) did not have diabetes, nor MS, 93 (12.8%) had MS without diabetes, 72 (9.9%) diabetes without MS, and 106 (14.5%) presented both conditions (WHO rules). According NCEP criteria were 60.7%, 14.8%, 7.8%, and 16.7%, respectively. Ten-year estimated stroke risk accounted for (WHO/NCEP) 8.4/9.1%, 10.8/10.5%, 18/17.3%, and 18.8/19.1%. Cumulated incidence for stroke events were: 2.8%, 1.4%, 5.4%, and 3.8% (WHO), and 2.5%, 2.8%, 3.5%, and 5.8%, respectively (NCEP).

CONCLUSIONS

Stroke risk scores were extremely increased among diabetic subjects irrespective to MS diagnose. The Framingham function probably overestimates stroke risk among Spanish individuals.