The metabolic syndrome as predictor of type 2 diabetes - The San Antonio Heart Study
The metabolic syndrome as predictor of type 2 diabetes - The San Antonio Heart Study
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DOI：
10.2337/diacare.26.11.3153
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发表时间：
2003-11-01
期刊：
影响因子：
16.2
通讯作者：
Haffner, SM
中科院分区：
文献类型：
--
作者：
Lorenzo, C;Okoloise, M;Haffner, SM
目的：口服糖耐量试验可识别糖尿病高危人群，但成本高且不方便。为了找到更好的2型糖尿病的预测因子，我们评估了代谢综合征的两种不同定义，因为胰岛素抵抗通常与代谢因素的聚类相关，经常先于2型糖尿病的发病。研究设计和方法：我们比较了国家胆固醇教育计划（NCEP）定义的预测2型糖尿病的能力，NCEP是1999年世界卫生组织（WHO）定义的修改版本，排除了2小时葡萄糖需求和糖耐量受损（IGT）。在圣安东尼奥心脏研究中，1734名参与者完成了7到8年的随访检查。结果：IGT和NCEP定义的敏感性高于修改后的WHO定义（分别为51.9、52.8和42.8%）。IGT的阳性预测值高于NCEP和修改后的WHO定义（分别为43.0%、30.8%和30.4%）。IGT和NCEP定义的结合将敏感性提高到70.8%，可接受的阳性预测值为29.7%。使用NCEP定义的2型糖尿病发病率风险独立于其他危险因素，包括IGT和空腹胰岛素（优势比3.30 95% CI 2.27-4.80）。当空腹血糖≥5.4 mmol/l时，NCEP诊断效果更好（敏感性62.0%，阳性预测值30.9%）。结论：代谢综合征独立于其他因素预测糖尿病。然而，NCEP的定义比1999年世卫组织修订的定义表现得更好。将空腹血糖临界值降低至5.4 mmol/l可改善代谢综合征对糖尿病的预测。
OBJECTIVE - The oral glucose tolerance test identifies high-risk subjects for diabetes, but it is costly and inconvenient. To find better predictors of type 2 diabetes, we evaluated two different definitions of the metabolic syndrome because insulin resistance, which is commonly associated with this clustering of metabolic factors, frequently precedes the onset of type 2 diabetes.RESEARCH DESIGN AND METHODS - We compared the ability of the National Cholesterol Education Program (NCEP) definition, a modified version of the 1999 World Health Organization (WHO) definition that excludes the 2-h glucose requirement, and impaired glucose tolerance (IGT) to predict incident type 2 diabetes. In the San Antonio Heart Study, 1,734 participants completed a 7- to 8-year follow-up examination.RESULTS - IGT and the NCEP definition had higher sensitivity than the modified WHO definition (51.9, 52.8, and 42.8%, respectively). IGT had a higher positive predictive value than the NCEP and modified WHO definitions (43.0, 30.8, and 30.4%, respectively). The combination of the IGT and NCEP definitions increased the sensitivity to 70.8% with an acceptable positive predictive value of 29.7%. Risk for incidence of type 2 diabetes using the NCEP definition was independent of other risk factors, including IGT and fasting insulin (odds ratio 3.30 95% CI 2.27-4.80). The NCEP definition performed better with fasting glucose = greater than or equal to5.4 mmol/l (sensitivity 62.0% and positive predictive value 30.9%).CONCLUSIONS - The metabolic syndrome predicts diabetes independently of other factors. However, the NCEP definition performs better than the modified 1999 WHO definition. Lowering the fasting glucose cutoff to 5.4 mmol/l improves the prediction of diabetes by the metabolic syndrome.