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He S, Wang J, Zhang X, Qian X, Yan S, Wang W, Zhang B, Chen X, An Y, Gong Q, Zhang L, Zhu X, Li H, Chen Y, Li G. Long-term influence of type 2 diabetes and metabolic syndrome on all-cause and cardiovascular death, and microvascular and macrovascular complications in Chinese adults - A 30-year follow-up of the Da Qing diabetes study. Diabetes Res Clin Pract 2022; 191:110048. [PMID: 36029887 DOI: 10.1016/j.diabres.2022.110048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/03/2022] [Accepted: 08/19/2022] [Indexed: 11/27/2022]
Abstract
AIMS To examine the long-term influence of metabolic syndrome (MetS) on death and vascular complications. METHODS Altogether, 1419 individuals with different levels of glycemia and MetS were recruited for this study. The participants were followed up for 30 years to assess outcomes. RESULTS Compared with the non_MetS, individuals with impaired glucose tolerance (IGT) plus MetS had a higher incidence (per 1000 person-years) of all-cause death (20.98 vs 11.70, hazard ratio [HR] = 1.84), macrovascular events (29.25 vs 15.94, HR = 1.36), and microvascular complications (10.66 vs 3.57, HR = 1.96). The incidence of these outcomes was even higher in participants with type 2 diabetes mellitus (T2DM) plus MetS. The T2DM without MetS shared a comparable risk profile of the outcomes with the T2DM plus MetS group (HRs were 3.45 vs 3.15, 2.21 vs 2.65, and 6.91 vs 7.41, respectively). CONCLUSIONS The degree of hyperglycemia in MetS is associated with the severity of death and both micro- and macrovascular complications. T2DM was associated with a comparable risk for all outcomes as T2DM plus MetS. The findings highlight the need of early prevention of diabetes in individuals with IGT plus MetS, while the justification to redefine a subgroup of patients with T2DM as having MetS remains to be clarified.
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Affiliation(s)
- Siyao He
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
| | - Jinping Wang
- Department of Cardiology, Da Qing First Hospital, Da Qing, China
| | - Xiaoxing Zhang
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
| | - Xin Qian
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
| | - Shuang Yan
- Department of Endocrinology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wenjuan Wang
- Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bo Zhang
- China-Japan Friendship Hospital, Beijing, China
| | | | - Yali An
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
| | - Qiuhong Gong
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
| | - Lihong Zhang
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
| | - Xiaolin Zhu
- University of Alabama at Birmingham, Diabetes Research and Training Center, Birmingham, AL 35233, USA
| | - Hui Li
- Department of Cardiology, Da Qing First Hospital, Da Qing, China
| | - Yanyan Chen
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
| | - Guangwei Li
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China; China-Japan Friendship Hospital, Beijing, China.
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Lee AS, Twigg SM, Flack JR. Metabolic syndrome in type 1 diabetes and its association with diabetes complications. Diabet Med 2021; 38:e14376. [PMID: 32738821 DOI: 10.1111/dme.14376] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/15/2020] [Accepted: 07/27/2020] [Indexed: 01/01/2023]
Abstract
AIM To assess the prevalence of metabolic syndrome in type 1 diabetes, and its age-related association with diabetes complications. METHODS Australian National Diabetes Information Audit and Benchmarking (ANDIAB) was a well-established quality audit programme. It provided cross-sectional data on people attending specialist diabetes services across Australia. We determined the prevalence of metabolic syndrome (WHO criteria) in adults with type 1 diabetes and its associations with diabetes complications across age groups. RESULTS Metabolic syndrome prevalence was 30% in 2120 adults with type 1 diabetes. Prevalence increased with age: 21% in those aged <40 years, 35% in those aged 40-60 years, and 44% in those aged >60 years (P<0.001), which was driven by an increase in hypertension rate. Metabolic syndrome was associated with a higher prevalence of microvascular, macrovascular and foot complications, with the greatest impact at a younger age. The odds ratio for macrovascular complications with metabolic syndrome, compared with without, was 5.9 (95% CI 2.1-16.4) in people aged <40 years, 2.7 (95% CI 1.7-4.2) in those aged 40-60 years, and 1.7 (95% CI 1.1-2.7) in those aged >60 years (all P < 0.05). Metformin use was higher in those with metabolic syndrome (16% vs 4%; P<0.001). CONCLUSIONS In this large Australian cohort, metabolic syndrome was common in type 1 diabetes and identified people at increased risk of the spectrum of diabetes complications, particularly in young to middle-aged adults. Potential clinical implications are that therapies targeting insulin resistance in this high-risk group may reduce diabetes complications and should be explored.
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Affiliation(s)
- Angela S Lee
- Department of Endocrinology, Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Central Clinical School in Sydney Medical School, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
| | - S M Twigg
- Department of Endocrinology, Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Central Clinical School in Sydney Medical School, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - J R Flack
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
- Western Sydney University, Sydney, NSW, Australia
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Alshkri M, Elmehdawi R. Metabolic Syndrome among Type-2 Diabetic Patients in Benghazi-Libya: A pilot study. Libyan J Med 2016. [DOI: 10.3402/ljm.v3i4.4789] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - R.R. Elmehdawi
- Medical Department Faculty of Medicine, Al-Arab Medical University. Benghazi, Libya
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Bigna JJR, Bahebeck J, Sobngwi E, Mbanya JC. Metabolic syndrome for sub-Saharan Africans diabetes with peripheral arterial disease: a case-control study. BMC Res Notes 2014; 7:104. [PMID: 24564882 PMCID: PMC3938317 DOI: 10.1186/1756-0500-7-104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 02/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, there is no value for the definition of abdominal obesity by measuring waist circumference in the Sub-Saharan Africa. Several definitions of metabolic syndrome (MS) have disparities concerning use of waist circumference, including International Diabetes Federation (IDF), American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) and National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) definitions. The aim of the study was to determine what value of waist circumference should be used and whether to use it as obligatory criterion in the metabolic syndrome in case of peripheral arterial disease (PAD). METHODS We conducted a case-control study in Cameroon. We included patients with diabetic foot and type 2 diabetes and excluded those with an Ankle Brachial Index (ABI) > 1.3. Cases were defined as patients with ABI ≤ 0.9 and controls with ABI > 0.9. The significant p value was < 0.05 and odds ratio (OR) with 95% confidence interval was used to measured risk for have PAD with MS. RESULTS We included 19 cases and 48 controls. The risk for having PAD with MS are for the IDF: OR = 4.7 (1.4-15.1), p = 0.008, for the AHA/NHLBI: OR = 5.8 (1.5-22.5), p = 0.007, for the NCEP-ATPIII: OR = 1.8 (0.6-5.6), p = 0.286. CONCLUSION Abdominal obesity should be defined according to the recommendations of the IDF and AHA/NHLBI and should not be an obligatory criterion in the definition of MS for research risk to have PAD on sub-Saharan Africa.
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Affiliation(s)
- Jean Joel R Bigna
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P,O, Box 1364, Yaoundé, Cameroon.
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Hermans MP. Impact of Fenofibrate on Type 2 Diabetes Patients with Features of the Metabolic Syndrome: Subgroup Analysis From FIELD. Curr Cardiol Rev 2011; 6:112-8. [PMID: 21532777 PMCID: PMC2892076 DOI: 10.2174/157340310791162686] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 02/25/2010] [Accepted: 03/08/2010] [Indexed: 02/08/2023] Open
Abstract
Given evidence of increasing prevalence in developed and developing countries, as a result of obesity trends and sedentary lifestyles, the metabolic syndrome represents an increasing burden on healthcare systems. Management guidelines for dyslipidaemia have primarily focused on LDL-C reduction; however, this approach fails to sufficiently address other lipid abnormalities associated with the metabolic syndrome. Atherogenic dyslipidaemia (characterized by elevated triglycerides and low HDL-C) is strongly associated with insulin-resistant states, such as type 2 diabetes and the metabolic syndrome, and is also a common finding among patients receiving treatment for dyslipidaemia. Intervening against atherogenic dyslipidaemia may address a substantial modifiable fraction of residual cardiovascular risk that remains after treatment with a statin. Recent findings from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study support this view. Fenofibrate treatment was shown to be especially effective in treating marked atherogenic dyslipidaemia, with a significant 27% relative risk reduction for cardiovascular events (P=0.0005, vs. 11%, P=0.035 for all patients) relative to placebo. These data, together with the earlier demonstration of significant microvascular benefits associated with this treatment, suggest a role for fenofibrate, in addition to statin therapy and lifestyle intervention, for reducing global vascular risk in type 2 diabetes patients and for impacting atherogenic dyslipidaemia associated with the metabolic syndrome.
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Affiliation(s)
- Michel P Hermans
- Cliniques Universitaires St-Luc, Service d'Endocrinologie et Nutrition, Brussels, Belgium
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Nassif PAN, Lopes AD, Lopes GL, Martins PR, Pedri LE, Varaschim M, Bopp DS. Alterações nos parâmetros pré e pós-operatórios de pacientes com síndrome metabólica, submetidos a Bypass gastrointestinal em Y de Roux. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2009. [DOI: 10.1590/s0102-67202009000300006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RACIONAL: A epidemia mundial de sobrepeso e obesidade afeta aproximadamente 1,7 bilhão de pessoas, havendo aumento nos casos de obesidade mórbida de 80% para mulheres e de 400% para homens desde 1970. A síndrome metabólica é transtorno complexo relacionado com resistência à insulina e obesidade abdominal, provocando alterações no metabolismo da glicose em vários tecidos e hiperinsulinemia. OBJETIVO: Verificar as alterações nos parâmetros pré e pós-operatórios em pacientes obesos mórbidos com síndrome metabólica, submetidos a bypass gastrointestinal em Y de Roux. MÉTODO: Casuística de 74 pacientes obesos, que apresentavam síndrome metabólica e submetidos a procedimento cirúrgico. Foram avaliados, além do IMC, a relação cintura-quadril, pressão arterial, colesterol total, HDL, LDL, triglicerídeos, glicemia de jejum no pré-operatório e no 1º e 4º meses de pós-operatório. Para variáveis que apresentaram simetria na sua distribuição, foi usado o teste t de Student para amostras pareadas. Para variáveis com distribuição assimétrica, foi usado o teste não-paramétrico de Wilcoxon. Valores de P<0,05 indicaram significância estatística. RESULTADOS: Obteve-se redução no 1º mês do pós-operatório no peso de 7,96%, IMC de 8%, relação cintura/quadril de 1,35%, colesterol total de 17,95%, HDL de 14,5%, LDL de 15,31%, TAG's de 30,29% e glicemia de 9,75%; no 4º mês, observou-se redução no peso de 14,94%, IMC de 20,08%, relação cintura/quadril de 5,96%, colesterol total de 21,27%, HDL de 3,53%, LDL de 23,72%, TAG's de 29,6% e na glicemia de 10,34%. CONCLUSÃO: Os parâmetros avaliados neste estudo tiveram melhora estatisticamente significante, com exceção do HDL-colesterol.
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AlSaraj F, McDermott JH, Cawood T, McAteer S, Ali M, Tormey W, Cockburn BN, Sreenan S. Prevalence of the metabolic syndrome in patients with diabetes mellitus. Ir J Med Sci 2009; 178:309-13. [PMID: 19495843 DOI: 10.1007/s11845-009-0302-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 02/01/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) is a vascular risk factor with prevalence in the general population of 17-25%. AIM To determine the prevalence of MetS in patients with diabetes mellitus (DM). METHODS A total of 200 patients [18% type 1 (T1DM), 82% type 2 (T2DM)] attending for annual review were studied. Standard blood tests were requested. Blood pressure and waist circumference were measured. Adult Treatment Panel III (ATP III) criteria for diagnosis of MetS were applied. RESULTS A total of 122 (61%) patients had MetS. More patients with T2DM (69.5%) than TIDM (22.2%) had MetS. Despite treatment of DM (100%), hypertension (69.5%) and dyslipidaemia (48.3%), 114 patients (57%) still met the criteria for MetS at time of study. CONCLUSIONS Most T2DM patients have MetS but it is uncommon in T1DM. Despite treatment, almost half of patients still met the criteria for MetS. Aggressive treatment of MetS components is required to reduce cardiovascular risk in DM.
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Affiliation(s)
- F AlSaraj
- Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, Dublin 15, Ireland.
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Cohen RA, Poppas A, Forman DE, Hoth KF, Haley AP, Gunstad J, Jefferson AL, Tate DF, Paul RH, Sweet LH, Ono M, Jerskey BA, Gerhard-Herman M. Vascular and cognitive functions associated with cardiovascular disease in the elderly. J Clin Exp Neuropsychol 2009; 31:96-110. [PMID: 18608677 PMCID: PMC2739675 DOI: 10.1080/13803390802014594] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study examines the relationship between systemic vascular function, neurocognitive performance, and structural brain abnormalities on magnetic resonance imaging (MRI) among geriatric outpatients with treated, stable cardiovascular disease and no history of neurological illness (n = 88, ages 56-85 years). Vascular function was assessed by cardiac ejection fraction and output, sequential systolic and diastolic blood pressures, flow mediated brachial artery reactivity (BAR), and carotid intima media thickness (IMT). White matter hyperintensities (WMH) on MRI were quantified and examined relative to cognitive and vascular function. Principal component analysis revealed two primary vascular components: one associated with cardiac function, the other with atherosclerotic burden/endothelial dysfunction. Both factors were significantly associated with cognitive function and WMH volume. Reduced systolic variability and increased IMT were most strongly related to reduced attention, executive function, and information-processing speed. These findings suggest the possibility that systemic vascular indices may provide proxy measures of cerebrovascular dysfunction and reinforce the importance of achieving greater understanding of interaction between systemic vascular disease and brain dysfunction among elderly people with cardiovascular disease.
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Affiliation(s)
- Ronald A Cohen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA.
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Alshkri M, Elmehdawi R. Metabolic Syndrome among Type-2 Diabetic Patients in Benghazi-Libya: A pilot study. Libyan J Med 2008; 3:177-80. [PMID: 21499470 PMCID: PMC3074309 DOI: 10.4176/080715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Metabolic syndrome is a cluster of three out of five conditions that are due to hyperinsulinemia: abdominal obesity, atherogenic dyslipidemia (high triglycerides and/or low HDL), elevated blood pressure, and elevated plasma glucose. The syndrome is highly prevalent in patients with type-2 diabetes mellitus and often precedes the onset of hyperglycemia. It has been shown that metabolic syndrome is an independent clinical indicator of macroand microvascular complications in diabetics. Aim and objectives the aim of this pilot study was to estimate the frequency and characteristics of metabolic syndrome among type-2 diabetic patients in Benghazi. Patients and methods: This cross-sectional study involved 99 randomly selected adult patients with type-2 diabetes mellitus. The patients were interviewed and examined, and their lipid profiles were checked 9-12 hours after overnight fasting. Metabolic syndrome was defined according to the criteria of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and of the International Diabetes Federation (IDF). Results About 92% of the patients had the metabolic syndrome according to ATP III criteria and 80.8% according to IDF criteria. Females were more affected, males with metabolic syndrome were significantly older, and females were significantly more obese. No significant difference was observed between males and females regarding waist circumference, HDL level and triglyceride level. The commonest and most important component of metabolic syndrome in the study group was low HDL. Conclusion Metabolic syndrome is common among Libyans with type-2 diabetes mellitus, and it is significantly more common in females than males. The most significant predictor of metabolic syndrome in type-2 diabetic patients in Benghazi is low HDL.
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Wong J, Molyneaux L, Zhao D, Constantino M, Gray RS, Twigg SM, Xu ZR, Yue DK. Different accelerators to early-onset Type 2 diabetes: a comparison of Anglo-Celtic and Chinese patients. J Diabetes Complications 2008; 22:389-94. [PMID: 18413217 DOI: 10.1016/j.jdiacomp.2007.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 04/11/2007] [Accepted: 04/23/2007] [Indexed: 01/06/2023]
Abstract
AIMS The "accelerator hypothesis" postulates that metabolic syndrome (MS) factors-overweight and insulin resistance-increase functional demand on islets, accelerating diabetes onset to a younger age in both Type 1 and Type 2 diabetes (T2DM). Previous research has focused only on the former. We examine to what extent the MS and individual components are accelerators to the earlier onset of T2DM in Anglo-Celtic and Chinese populations. METHODS A cross-sectional study of 1016 Anglo-Celtic and 1514 Chinese patients with recent-onset diabetes (duration <2 years) evaluated over a 12-year period. The MS syndrome and components were analyzed after stratification by age at presentation. RESULTS The Anglo-Celtic group shows a high prevalence of MS in early-onset disease and a striking inverse relationship of body mass index (BMI) with age at presentation. For every increase in BMI of 1 kg/m(2), there is a reduction in the age of presentation by 0.5 years (r=-0.3; P<.0001) .Younger groups had a higher prevalence of insulin resistance, elevated triglyceride (Tg), and low high-density lipoprotein cholesterol (HDL-C) (P<.0001 for trend for all three indices). In contrast, the Chinese group showed no relationship between age of presentation with BMI, insulin resistance, Tg, or HDL-C. CONCLUSIONS MS factors are important accelerators for T2DM in the Anglo-Celtic but not the Chinese population. This suggests that earlier onset of pancreatic beta cell deficiency is more important as an accelerator of diabetes presentation in Chinese. These data confirm the heterogeneity of T2DM and support the need for more ethnic specific strategies in diabetes prevention.
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Affiliation(s)
- Jencia Wong
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
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