نقش سندرم متابوليك در بروز ديابت و اختلال تحمل گلوكز

Metabolic syndrome and development of diabetes and impaired glucose tolerance

Introduction: Diabetes mellitus seems to be the final stage of metabolic syndrome. The purpose of this study was to determine the importance of metabolic syndrome and its components in development of diabetes. Material and Methods: In Tehran Lipid and Glucose Study, 3995 people above the age of 20 (2353 females), were followed up for 1 to 4 years till December 2003. In this cohort study, metabolic syndrome at the beginning of the follow-up was defined, according to NCEP criteria, by the presence of three or more of the following components: abdominal obesity, hypertriglyceridemia, low HDL-C, high blood pressure, and high fasting glucose (above 110 mg/dL). Diabetes was defined as a fasting blood glucose above 126 or 2-hour post glucose load above 200 mgldL, or use of hypoglycemic medication. The incidence of diabetes after follow up was compared between those with non-diabetic metabolic syndrome at the beginning of the study and healthy controls. Chi-square test and logistic regression along with ROC analysis were used. Results: The mean follow-up interval was 3.2 years. 117 non-diabetic individuals developed diabetes in this period which means an incidence risk of 4%. The incidence of diabetes in individuals with metabolic syndrome was more than in normal subjects (8% vs. 2.3%, P<0.001). The chances of developing diabetes after this period were higher in non-diabetics with metabolic syndrome than in normal subjects (0R=3.1; 95%CI: 2.1-4.6). Multivariate logistic regression showed that high FPG below diabetic range (OR=11.4, 95%Cl: 7.0-18.63), abdominal obesity (OR=2.1; 95%Cl: 1.4-3.1) and hypertension (OR=2.0; 95%Cl: 1.4-3.0) at the beginning of the study, were independent risk factors for developing diabetes after 3.2 years. The risk of developing IGT and IFG in normal individuals was also related to all components of the metabolic syndrome. Conclusions: Non-diabetic patients with metabolic syndrome have a greater chance of developing diabetes mellitus and milder forms of glucose metabolism disorders, and those with high plasma glucose, hypertension and abdominal obesity are at greater risk.