Metabolic syndrome in newly-

diagnosed type 2 dabetes

MD. Nguyeãn Thò Thu Thaûo
Prof.PhD. Nguyeãn Thy Khueâ
 CONTENTS

1. PREFACE

2. OBJECTS & METHODS

3. RESULTS

4. CONCLUSION
 1. PREFACE (1)

Metabolic syndrome (MS): central obesity, insulin resistance or

glucose intolerance, dyslipidemia and hypertension.

Described over 40yrs ago by Vague; “Syndrome X ” “Reaven

syndrome”, “Deadly Quarted ”, “Insulin resistance syndrome”,

“multimetabolic syndrome”  “Metabolic syndrome”.

The prevalence of ms according to atp iii Guidelines

Singapore ( population ) 12.2%

American ( population ) 23.9%

TH Daøng (obesity ) 44%

NH Nam (hypertension ) 51.4%

LTT Tònh (postmenaupose ) 60%

NT Coâng (NIDDM ) 86%

Our (newly – diagnosed NIDDM ) 69.2%

 1. PREFACE (2)

MS can be present up to 10 yrs before diagnosis of NIDDM.

Risk factor for type 2 diabetes and CVD.

Increases the prevalence of chronic complications &

cardiovascular mortality in type 2 DM.

Find out MS to treat type 2 diabetes completely.

 2. OBJECTS - methods
Objects:
Determine the clinical features and prevalence of the MS in
newly – diangosed type 2 diabetes.
Find the relationship between MS and chronic complications
of diabetes.

Methods
Cross – sectional descriptive study.
Use statistics and SPSS software to process data.
 DESIGN OF STUDY
Diagnosed DM: WHO 1998.
> 30 years old and no use hypoglyceamic agents before.
BP, waist, TG, HDL, FPG, FSI, microalbuminuria…
Diagnosed obesity (to Asians): BMI ≥ 25 kg/m2
HOMA – IR = FSI ( µU) / ml× FPG ( mmol / ml ) / 22.5
Insulin resistance: HOMA – IR > 2.5
MS (ATP III to Asians) : ≥ 2 factors
Central obesity: WC > 90 cm (♂) & > 80 cm (♀).
Triglycerides  150mg/dl
HDL cholesterol < 40mg/dl (♂); < 50mg/dl (♀)
BP  130/  85mmHg
 3. Results (1)
1. Clinical features of MS
120 patients: 90 82,1%
80
M: 53.3%; F: 46.7% 70
57,8%

Mean age: 55  11.5 60

50
MS: 69.2% 40
30
Mean age: 56.9  11.4. 20
F > M ( p = 0.018). 10
0
M (37) F (46)

NT Coâng: F > M; Jaberl13l : M > F

 3. Results (2)
Common age: 50 – 59yrs

Japan: 50 – 59 years
 Components of metabolic syndrome

Group Study MS Non MS OR P

Hypertension (%) 77 (64.2) 62 (74.7) 15 (40.5) 4.8 0.001

High TG* (%) 86 (71.7) 69 (83.1) 17 (45.9) 5.1 0.001

Low HDL*** (%) 46 (38.3) 41 (49.4) 5 (13.5) 6.6 0.01

Central obesity (%) 54 (45.0) 53 (63.9) 1 (2.7) 52.8 0.001

Obesity (%) 31 (25.8) 29 (34.9) 3 (5.4) 7.7 0.013

Normal BMI ** (%) 60 (50) 37 (44.6) 23 (62.2)

IR (%) 88 (73.3) 64 (77.1) 24 (64.9) 1.8 0.22

Total 120 83 37

(*High TG:  150mg/dl; **Normal BMI : 18 – 22.9, ***Low HDL: ♂< 40mg/dl, ♀< 50mg/dl)
 3. Results (3)

Study MS Non MS P

FPG (mmol/L) 13.8 ± 5.4 13.7  5.7 14.0  4.8 0.82

HbA1c (%) 10.7 ± 2.8 10.7  2.8 10.8  2.8 0.87

FSI (U/mL) 9.7  5.9 10.7  6.5 7.3  3.4 0.007

Peptid C (g/mL)* 3.1  2.6 3.5  2.9 2.3  1.4 0.025

135.2 ± 21.7 / 139.5  21.9 / 125.8  18.5 /

BP (mmHg) 0.003
80.8 ± 13.1 83.1 12.3 75.9  13.7

Total 120 83 37
 3. Results (4)

Study (%) MS (%) Non MS (%) P

High Insulin (> 18U/mL) 12 (10) 12 (14.5) 0 (0.0)

Low Insulin (< 4,82 U/mL) 20 (16.7) 10 (12.1) 10 (27)

0.015
Normal Insulin * 88 (73.3) 61 (73.4) 27 (73)

Insulin secretion disorder 108 (90%) 71 (85.5%) 37 (100%)

Normal Insulinaemic concentration in most of patients with MS Insulin

secretion disorder 90% in total study; 85.5% in MS.
 3. Results (5)
FSI High Normal Low p
(U/mL) (> (< 4.82U/mL)
18U/mL
)
FPG
12.9  5.8 13.2  4.8 17.1  6.9 0.02
(mmol/dL)
Peptid C
4.8  3 3.1  2.7 2.2  1.4 0.04
(ng/dL)
 3. Results (6)
2. Relationship b/w MS – chronic complications
Study MS Non MS OR p

Chronic complications (%) 97 (80.8) 77 (92.8) 20 (54.1) 10.5 0.001

Microvascular (%) 80 (66.7) 62 (74.7) 18 (48.6) 3.3 0.011
Macrovascular (%) 70 (58.3) 60 (72.3) 10 (27.0) 7.6 0.001
Microalbuminuria (%) 64 (53.3) 50 (60.2) 14 (37.8) 2.5 0.04
CHD (%) 40 (33.3) 33 (39.8) 7 (13.3) 2.8 0.04

The prevalence of chronic complications was 10.5 times higher in MS patient

than in patient without MS; in which CHD 2.8 times; microalbuminuria times.
 conclusion

The prevalence of MS: 69.2%, increases with age, more

commonly in female than in male, highest in 50 – 59yrs, no

difference FPG and HbA1c level.

Normal FSI in most of MS patients, insulin secretion disorder

was higher insulin resistance (85.5% vs 77.1%).

Hypertriglycemia was the highest ratio in MS

 conclusion (2)

Central obesity was the strongest risk for MS

MS can be present in patients with normal BMI

Newly-diagnosed in type 2 diabetes patients with MS have

10.5 fold increase in chronic complications than that do not

have MS, in which CHD 2.8 fold & microalbuminuria 2.5 fold.
 PETITION

Find out and treat metabolic syndrome early in newly-

diagnosed type 2 diabetes to prevent chronic complications

and cardiovascular mortality.

Pay attention to central obesity, hypertension,

hypertriglycemia and even patients with normal BMI.

Need a lot of studies with large size.

New informations for idf worlwide
definition of the ms
who clinical identification of the ms (1998)
IFG / IGT/ NIDDM / Insulin resistance +  2 risk factors:
 Hypertension  140/90 mmHg
 TG  1.7mmol/l (150mg/dl)
 HDL cholesterol < 0.9 mmol/l (35mg/dl) (♂)
< 1 mmol/l (39mg/dl) (♀õ)
 Central obesity: WHR > 0.9(♂)
> 0.85 (♀õ)
 BMI > 30 kg/m2
 Microalbuminuria  20 g/min or A/C  30 mg/g
Atp iii clinical identification of the ms
Three or more of the following five risk factors:
Central obesity Waist circumference
 Men > 102cm
 Women > 88cm
Triglycerides ≥ 150mg/dL (1.7mmol/L)
HDL cholesterol
 Men < 40mg/dL (1.03mmol/L)
 Women < 50mg/dL (1.29mmol/L)
Blood pressure ≥ 130 / ≥ 85mmHg
Fasting glucose ≥ 110mg/dL (6.1mmol/L)

WC > 90 cm (men ); WC > 80 cm (women ) for the Asians

 egir clinical identification of the ms (1999)

Insulin resistance +  2 risk factors:

 IFG / IGT / NIDDM
 Hypertension  140/90 mmHg
 Triglycerides > 2 mmol/l
 HDL cholesterol < 1 mmol/l
 Cetral obesity: (WC) > 94 cm (♂); > 80 cm (♀)
Aace clinical criteria for diagnosis of the MS (2003)

Diagnosis depend on clinical judgment based on risk factors:

 BMI:  25kg/m2
 Triglycerides  150 mg/dl
 HDL cholesterol < 40 mg/dl (♂); < 50 mg/dl (♀)
 BP  130 /  85 mmHg
 IFG  110 mg/dl
 IGT >140mg/dl
 Other risk factors: family history of NIDDM, hypertension,
or CVD; polycystic ovary syndrome…
 The new Internation Diabetes Federation (IDF)
definition (2005)
 Central obesity (for Europid): M ≥ 94cm and F ≥ 80cm
 Plus any two/ four factors:
 TG: > 150 mg/dL (1.7 mmol/L), or specific treatment for this lipid
abnormality
 HDL: M < 40 mg/dL (0.9 mmol/L) and F < 50 mg/dL (1.1 mmol/L) or
specific treatment for this lipid abnormality
 BP: systolic BP ≥ 130 mmHg or diastolic BP ≥ 85 mmHg, or treatment
of previously diagnosed hypertension
 FPG ≥ 100 mg/dL (5.6 mmol/L), or previously diagnosed type 2 diabetes
 Ethnic specific values for waist circumference

Country/Ethnic group Waist

circumference*
Europids, Sub-Saharan Africans, Eastern Male ≥ 94cm
Mediterranean and Middle East (Arab)
Female ≥ 80cm
South Asians, Chinese, south and cetral Male ≥ 90cm
Americans
Female ≥ 80cm
Japanese Male ≥ 85cm
Female ≥ 90cm
* In future epidemiological studies of populations of Europid origin, prevalence
should be given using both European and North American cut-points to allow
better comparisons.
Additional metabolic criteria for research
General body fat distribution (DXA) distribution
Central fat distribution (CT/M RI)
Abnormal body fat
Adipose tissue biomarkers: leptin, adiponectin
Liver fat content (MRS)
Atherogenic dyslipidaemia ApoB (or non-HDL-c)
(beyond elevated TG and low Small LDL particles
HDL)
Dysglycaemia OGTT
Fasting insulin/proinsulin levels
HOMA-IR
Insulin resistance (other than
Insulin resistance by Bergman Minimal Model
elevated FBG)
Elevated free fatty acids (fasting and during OGTT)
M value from clamp
Vascular dysregulation (beyond Measurement of endothelial dysfunction
elevated BP) Microalbuminuria
Elevated high sensitivity C-reactive protein
Elevated inflammatory cytokines (eg TN F-alpha, IL-
Proinflammatory state
6)
Decrease in adiponectin plasma levels
Fibrinolytic factors (PAl-i etc)
Prothrombotic state
Clotting factors (fibrinogen etc)
Thank you very much
for your attention
 Components of metabolic syndrome
IR 77.1
73.3

Normal BMI 44.6

50

Obesity 34.9
25.8

Central obesity 63.9

45

49.4
Low HDL 38.3

83.1
High TG 71.7

74.7
Hypertension 64.2

0 10 20 30 40 50 60 70 80 90
Study MS