Impact of excluding hyperglycemia from international diabetes federation metabolic syndrome diagnostic criteria on prevalence of the syndrome and its association with microvascular complications, in adult patients with type 1 diabetes.

Autor: Lecumberri E; Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain., Nattero-Chávez L; Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain. marialia.nattero@salud.madrid.org.; Grupo de Investigación en Diabetes, Obesidad y Reproducción Humana. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain. marialia.nattero@salud.madrid.org., Quiñones Silva J; Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Department of Endocrinology and Nutrition, Hospital General Universitario de Alicante, Alicante, Spain., Alonso Díaz S; Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Department of Endocrinology and Nutrition, Hospital Universitario de Elche, Elche, Spain., Fernández-Durán E; Grupo de Investigación en Diabetes, Obesidad y Reproducción Humana. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain., Dorado Avendaño B; Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain., Escobar-Morreale HF; Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Grupo de Investigación en Diabetes, Obesidad y Reproducción Humana. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.; Universidad de Alcalá, Madrid, Spain., Luque-Ramírez M; Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Grupo de Investigación en Diabetes, Obesidad y Reproducción Humana. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.; Universidad de Alcalá, Madrid, Spain.
Jazyk: angličtina
Zdroj: Endocrine [Endocrine] 2022 Jun; Vol. 76 (3), pp. 601-611. Date of Electronic Publication: 2022 Mar 28.
DOI: 10.1007/s12020-022-03041-8
Abstrakt: Background: We aimed to determine, in patients with type 1 diabetes (T1DM), the impact of excluding hyperglycemia as a criterion from the International Diabetes Federation (IDF) definition of the metabolic syndrome (MetS), both on its prevalence and on its association with micro and macrovascular complications and markers of subclinical inflammation.
Methods: A cross-sectional design, including 280 patients with T1DM. We defined MetS by three different models: (i) the standard IDF criteria, (ii) a modification consisting of excluding of hyperglycemia as a criterion (modified IDF criteria) and (iii) a modification consisting in changing the hyperglycemia by insulin resistance (MetS + IR model) defined by the estimated glucose disposal rate. Microvascular complications and cardioautonomic neuropathy were assessed. We measured an inflammatory panel including high sensitivity C reactive protein, erythrocyte sedimentation rate, homocysteine, and fibrinogen concentrations.
Results: After excluding hyperglycemia, the prevalence of MetS was 6.4% (95%CI: 4.1 to 9.9) compared with 20.7% (95%CI: 16.3 to 25.8) using standard IDF criteria. After adjusting for duration of diabetes, all three MetS definitions increased the odds for having microvascular complications [OR: 6.012 (2.208-16.307) for modified definition; OR: 5.176 (2.555-10.486) for standard definition and [OR: 3.374 (1.649-8.456) for MetS+IR model]. However, the both modified IDF models for MetS showed better predictive performance than standard criteria for suffering from neuropathy, nephropathy, cardiovascular disease and were associated with markers of subclinical inflammation.
Conclusions: The prevalence of MetS significantly varies as a function whether or not hyperglycemia is included as a diagnostic criterion. The subset of patients fulfilling the modified MetS definitions may reflect better the concept of metabolic syndrome in T1DM. These modified definitions were accompanied by a poorer metabolic control and lipid profile, showing the worse inflammatory biomarker profiles and higher odds for micro- and macrovascular complications. In patients with T1DM, the inclusion of insulin resistance instead of hyperglycemia as a criterion of MetS may be of interest in routine clinical practice.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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