The burden of non-communicable disease in the developing countries is increasing, and leading to high mortality rates [1]. Nowadays Type 2 Diabetes (T2D) is pandemic. According to international diabetes federation report indicates that more than 415 million of people worldwide adults have diabetes and is expected to rise to 642 million by 2040 [2]. The metabolic syndrome (MetS) is complex with high socioeconomic impact due to its association with increased morbidity and mortality [3]. Metabolic syndrome has attracted increased attention due to its significant impact on cardiovascular diseases (CVD) and its high prevalence in T2D patients [4-9]. Metabolic syndrome can be defined as a cluster of interconnected cardio-metabolic dysfunctions which is characterized by the increase in fasting blood sugar, waist circumference, blood pressure, triglycerides (TG), and reduction in high-density lipoprotein cholesterol (HDLc) [10, 11].
Globally, 20-25% of the adult population has MetS and they are twice as likely to die from it; and they are three times more likely to have a heart attack or stroke compared with people without the syndrome [2, 12]. This increase in MetS globally is associated wit
The burden of non-communicable diseases in developing countries is increasing and leading to high mortality rates [1]. Nowadays, Type 2 Diabetes (T2D) is pandemic. The International Diabetes Federation (IDF) estimated that more than 415 million people have diabetes, and this number is expected to reach 642 million by 2040 [2]. The metabolic syndrome (MetS) is a complex disorder with a high socioeconomic impact on global health due to its association with increased morbidity and mortality [3]. The MetS has attracted increased attention due to its significant impact on cardiovascular diseases (CVD) and its high prevalence in T2D patients [4-9]. The MetS can be defined as a cluster of cardio-metabolic dysfunctions which is characterized by the increase in fasting blood glucose (FBG), waist circumference (WC), blood pressure (BP), triglycerides (TG), and reduction in high-density lipoprotein cholesterol (HDL-C) [10, 11].
It is estimated that 20-25% of the world’s adult population suffers from MetS. People with MetS have a 3-fold increase in the risk of coronary heart disease and stroke and a 2-fold increased risk of mortality from cardio- and cerebrovascular disease compared with people without the MetS [2, 12]. This global increase in MetS is associated with the worldwide epidemic of obesity andT2D. Obesity and physical inactivity are the driving force for MetS, and a person with MetS has a 5-fold relative risk to develop T2D [6, 13-15]. Overweight and obesity lead to adverse metabolic effects on BP, HDL-C, TG, and impaired glucose tolerance (IGT) [16].
The National Cholesterol Education Programs Adult Treatment Panel III (NCEP ATP III) proposed a simple set of diagnostic criteria for MetS based on WC, TG, HDL-C, BP, and FBG levels [17]. In 2005, the IDF modified the MetS definition, which stated that WC is necessary for the diagnosis of MetS along with two or more of the other MetS parameters, including the treatment of the above Mets parameters [18]. In the same year, the American Heart Association and the National Heart, Lung, and Blood Institute revised the NCEP ATP III criteria and affirmed its overall utility and validity and proposed that it continued to be used with minor modifications and clarifications [19] (Table 1).
In 2009, a meeting between several organizations: International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity attempted to unify criteria [20]. In this meeting, the IDF criteria were modified, and it was agreed that WC should not be an obligatory component for the diagnosis of MetS, and three abnormal findings out of 5 would qualify a person for the MetS. However, there is no consensus on the definition of MetS worldwide. Studies revealed that the impact of different definitions of MetS on the risk of future CVD and T2D is discrepant [21, 22].
Several studies have assessed the MetS among normal individuals in different populations, while few studies evaluated the MetS among T2D patients. Taking into consideration, T2D patients who had MetS also have cardiovascular risk factors. Therefore, the diagnosis of MetS in those T2D patients is very important for the detection, prevention, and treatment of the underlying risk factors [23, 24]. This research aims to study the relationship of MetS, diagnosed by the IDF or the revised NCEP ATP III criteria, with glycemic control FBG, HbA1c, C-peptide, and insulin resistance) in T2D patients.
h the worldwide epidemic of obesity and diabetes. Obesity and physical inactivity are the driving force for MetS and a person with MetS has 5-fold relative risk to develop diabetes[
6,
13-15]. Overweight and obesity lead to adverse metabolic effects on blood pressure, HDL cholesterol, TG and impaired glucose tolerance (IGT) [
16].
The National Cholesterol Education Programs Adult Treatment Panel III (NCEP-ATPIII) proposed a simple set of diagnostic criteria for MetS based on waist circumference, TG, HDL-C, blood pressure, and fasting glucose level [17]. In 2005, the International Diabetes Federation (IDF) modified the MetS definition, which stated that waist circumference is necessary for the diagnosis of MetS along with any two of the other MetS parameters that were suggested by NCEP while IDF included the treatment of the above parameters as well [18]. In the same year the American Heart Association and the National Heart, Lung, and Blood Institute revised the NCEP criteria and affirmed its overall utility and validity and proposed that it continued to be used with minor modifications and clarifications [19] (Table 1).
Table 1: Diagnostic criteria of metabolic syndrome
Parameters
|
Revised NCEP
|
IDF
|
Definition
|
Any three of the following 5 features
|
Increased waist circumference
men ≥ 90 cm, women ≥ 80 cm
along with any 2 of following features
|
Elevated waist circumference
|
≥102 cm in men
≥ 88 cm in women
|
Triglyceride
|
≥1.7 mmol/l or TG treatment
|
HDL cholesterol
|
Men <1.03 mmol/l or women <1.29 mmol/l or HDL cholesterol treatment
|
Blood pressure
|
Systolic ≥ 130 mmHg or Diastolic ≥85 mmHg or hypertension treatment or previously diagnosed hypertension
|
Glucose
|
≥5.6 mmol/l or treatment for elevated glucose or previously diagnosed type 2 diabetes
|
aSub-Saharan Africans, Eastern Mediterranean and Middle East (Arab) populations use European and Ethnic South and Central Americans Use South Asia.
In 2009, a meeting between several organization: International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity attempt to unify criteria [20]. In this meeting, the IDF criteria was modified and it was agreed that waist circumference should not be an obligatory component and three abnormal findings out of 5 would qualify a person for the MetS. However, there is no consensus on the definition of MetS worldwide. Studies revealed that the impact of different definitions of MetS on the risk of future CVD and diabetes is discrepant [21, 22].
Several studies have assessed the MetS among normal individual in different populations whereas few studies assessed the MetS among T2D. Taking into consideration, diabetic patients who had MetS also have cardiovascular risk factors, therefore the diagnosis of MetS in those patients is very important for detection, prevention, and treatment of the underlying risk factors and for the reduction of the cardiovascular disease burden in the general population [23, 24]. This research aims to study the relationship of metabolic syndrome, diagnosed by International Diabetes Federation or the revised National Cholesterol Education Programs (NCEP-R) criteria, with glycemic control including fasting glucose, glycated hemoglobin, C-peptide and insulin resistance in T2D patients.