Impact of Metabolic Syndrome Compared With Impaired Fasting Glucose on the Development of Type 2 Diabetes in a General Japanese Population

Q: What are the key findings of this study?

Metabolic syndrome increased incident type 2 diabetes risk in both men and women, independent of impaired fasting glucose.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Metabolic syndrome and impaired fasting glucose in nondiabetic adults (n=1935). Intervention: Metabolic syndrome (updated 2005 NCEP ATP III criteria) vs. Absence of metabolic syndrome (and comparison with impaired fasting glucose). Primary outcome: Incident type 2 diabetes (HR 2.58 in men; HR 3.69 in women, 95% CI 1.85-3.59, p=<0.001).

Q: What does this research mean for the field?

Metabolic syndrome significantly increases the risk of incident type 2 diabetes independently of impaired fasting glucose in both men and women. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Naoko Mukai; Yasufumi Doi; Toshiharu Ninomiya; Jun Hata; Koji Yonemoto; Masanori Iwase; Mitsuo Iida; Yutaka Kiyohara

doi:10.2337/dc09-0896

September 3, 2009Diabetes CareOpen Access

Impact of Metabolic Syndrome Compared With Impaired Fasting Glucose on the Development of Type 2 Diabetes in a General Japanese Population

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Key result

Metabolic syndrome linked to ~2.6-fold higher incident type 2 diabetes risk independent of fasting glucose.

HR 2.58 in men; HR 3.69 in women
95% CI 1.85-3.59
P<0.001
n=1,935

Why the study?

Whether metabolic syndrome predicts incident type 2 diabetes more effectively than impaired fasting glucose in a general Japanese population was uncertain.

Does metabolic syndrome predict incident type 2 diabetes more effectively than impaired fasting glucose in a general Japanese population?

Study Design

Type

Cohort (n=1,935)

Multicenter

No

Structured PICO

Does metabolic syndrome predict incident type 2 diabetes more effectively than impaired fasting glucose in a general Japanese population?

P

Population

1,935 nondiabetic Japanese adults aged 40-79 years (59% female) from the town of Hisayama, followed prospectively for a mean of 11.8 years.

E

Exposure

Metabolic syndrome defined by the updated 2005 NCEP ATP III criteria (presence of at least 3 of 5 factors: FPG >=5.6 mmol/l, Asian central obesity [waist circumference >=90 cm in men and >=80 cm in women], triglycerides >=1.68 mmol/l, HDL cholesterol <1.03 mmol/l in men and <1.29 mmol/l in women, and blood pressure >=130/85 mmHg or antihypertensive medication use), evaluated alongside or stratified by impaired fasting glucose (IFG).

C

Comparator

Absence of metabolic syndrome (and absence of impaired fasting glucose in stratified analyses).

O

Outcome

Incident type 2 diabetes (defined by 2003 ADA criteria as FPG >=7.0 mmol/l and/or 2-h postload glucose >=11.1 mmol/l on 75-g OGTT and/or use of antidiabetes medication) over a mean follow-up of 11.8 years.hard clinical

Main Result

Hazard Ratio: 2.58 (95% CI 1.85–3.59)

p-value: p=<0.001

Limitations

Diagnosis of metabolic syndrome was based on a single measurement of its components at baseline, and risk factor levels might have changed during follow-up due to lifestyle or medication modifications.
Lacked information on antilipidemic drugs such as fibrates and nicotinic acid, which could have affected HDL cholesterol and triglyceride metabolism and led to misclassification.
Diagnosis of metabolic syndrome was based on a single baseline measurement of its components, which may have changed during follow-up.
Lack of information on antilipidemic medications such as fibrates and nicotinic acid, which could affect HDL cholesterol and triglyceride levels.

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Implication

Metabolic syndrome is an independent risk factor for incident type 2 diabetes beyond impaired fasting glucose alone in a general Japanese population, supporting its clinical utility for diabetes risk stratification in Asian populations.

Abstract

OBJECTIVE: We examined whether metabolic syndrome predicts incident type 2 diabetes more effectively than impaired fasting glucose (IFG) in a general Japanese population. RESEARCH DESIGN AND METHODS: A total of 1,935 nondiabetic subjects aged 40-79 years were followed-up prospectively for a mean of 11.8 years. RESULTS: During the follow-up, 286 subjects developed type 2 diabetes. Compared with those without metabolic syndrome, the multivariate-adjusted hazard ratio (HR) for incident type 2 diabetes was significantly higher in subjects of both sexes with metabolic syndrome, even after adjustment for confounding factors, age, family history of diabetes, total cholesterol, alcohol intake, smoking habits, and regular exercise (men: HR 2.58 [95% CI 1.85-3.59]; women: 3.69 [2.58-5.27]). The multivariate-adjusted HR of metabolic syndrome for type 2 diabetes was slightly lower in men and similar in women compared with that of IFG. The multivariate-adjusted HR for type 2 diabetes rose progressively as the number of metabolic syndrome components increased in both subjects with and without IFG. In stratified analysis, the multivariate-adjusted risk of type 2 diabetes was significantly higher in subjects with metabolic syndrome alone (2.37 [1.45-3.88]) or IFG alone (3.49 [2.57-4.74]) and markedly increased in subjects with both metabolic syndrome and IFG (6.76 [4.75-9.61]) than in subjects with neither metabolic syndrome nor IFG. Furthermore, the multivariate-adjusted risk for type 2 diabetes was also significantly higher in subjects with both metabolic syndrome and IFG than in those with either one alone (both P < 0.001). CONCLUSIONS: Our findings suggest that metabolic syndrome significantly increases the risk of incident type 2 diabetes, independent of IFG, and is therefore a valuable tool to identify individuals at high risk of type 2 diabetes.

Discussion

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Cite This Study

Mukai et al. (2009) conducted a cohort in Metabolic syndrome and impaired fasting glucose in nondiabetic adults (n=1,935). Metabolic syndrome (updated 2005 NCEP ATP III criteria) vs. Absence of metabolic syndrome (and comparison with impaired fasting glucose) was evaluated on Incident type 2 diabetes (HR 2.58 in men; HR 3.69 in women, 95% CI 1.85-3.59, p=<0.001). Metabolic syndrome increased incident type 2 diabetes risk in both men and women, independent of impaired fasting glucose.

synapsesocial.com/papers/6ac46e0a9f11621413acbfd6 https://doi.org/10.2337/dc09-0896

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Impact of Metabolic Syndrome Compared With Impaired Fasting Glucose on the Development of Type 2 Diabetes in a General Japanese Population

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Impact of Metabolic Syndrome Compared With Impaired Fasting Glucose on the Development of Type 2 Diabetes in a General Japanese Population

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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