Patient Care Endocrinology & Cardiology - October 2007 - (Page 14)

I Metabolic syndrome Drugs mentioned in this article Acarbose (Precose) Aspirin Ezetimibe (Zetia) Fenofibrate (Tricor) Gemfibrozil (Lopid) Hydrochlorothiazide Metformin (Glucophage) Nicotinic acid Ramipril (Altace) spring Study, a diagnosis of the metabolic syndrome predicted a 5-fold, 8-year future risk of diabetes in males and a 6-fold increase in the future risk of diabetes in females.19 Identifying patients with a high risk of prediabetes by screening can prevent costly outcomes of increased mortality and morbidity caused by DM and its complications. According to the ADA, screening for prediabetes and DM should be considered in adults who are overweight (BMI 25 kg/m2) and have IFG, IGT, or certain other risk factors.20 Persons with prediabetes have IFG, IGT, or both. IGT is a stronger risk factor than IFG in predicting the onset of DM.7 Individuals with IGT are usually euglycemic and may have normal or near normal glycated hemoglobin levels. IGT is diagnosed with an OGTT (specificity 92%, sensitivity 52%, in the prediction of diabetes). Glucose levels 2 hours after a 75-g oral loading dose are well-known independent predictors of CVD. The presence of IGT, in addition to ATP III metabolic syndrome criteria, increased the sensitivity of this test to 70.8%, with a positive predictive value of 29.7% for the development of DM.21,22 Although IFG has been shown to be the strongest independent predictor of IGT, when IFG is used alone it is not sufficient to accurately detect most cases of IGT because of its low prevalence.23 Combining IFG with other risk factors has been shown in multiple studies to improve prediction of IGT and diabetes. Using a combination of overweight (BMI 25 kg/m2), Mexican American background, older age, hypertension, and triglyceride levels greater than 150 mg/dL as independent risk factors, researchers developed a scoring system for predicting IGT.24 The score allotted for each risk factor was as follows: • Fasting glucose of 101 to 109 mg/dL = 1 • Fasting glucose of 110 to 125 mg/dL = 3 • Age 60 to 74 years = 2 • Triglycerides greater than 150 mg/dL or BMI greater than 30 kg/m2 = 1 • Mexican American ethnicity = 1 • Hypertension = 1. The maximum possible score is 8. When a score of 2 is used to define a positive test, the sensitivity of the test is 86%, indicating that subjects with a score of less than 2 have a low likelihood of having IGT and that an OGTT may not be needed in this group. When a score of 6 is used to define a positive test, the specificity of the test is 97%, indicating that subjects with a score 6 or greater have a high likelihood of having IGT. When fasting plasma glucose levels are in the normal range, subjects with a score 6 or greater may need an OGTT to help identify individuals at high risk for IGT and diabetes. A score between 2 and 6 will not help clinicians determine the risk of IGT; however, in subjects with low HDL, high triglycerides, and obesity, further workup can be planned.24 Current data suggest that insulin resistance is associated with MI or stroke, even after adjustment for age, sex, race, and smoking.25 Although WHO and EGIR recommend using direct measure of quantitative insulin sensitivity in addition to a diagnosis of either IFG/IGT or type 2 DM to define the metabolic syndrome, this is not feasible in daily clinical practice. Other associated diseases When compared with the general population, patients with the metabolic syndrome have an increased incidence of the following diseases: nonalcoholic fatty liver disease (NAFLD), polycystic ovary syndrome (PCOS), gestational diabetes (3-fold higher), obstructive sleep apnea, prostate cancer (1.9fold higher), gallstones, depression (4-fold higher), and cognitive decline in the elderly population (4fold higher) (see Table 2, page 15). NAFLD affects 20% of the general population and accounts for the vast majority of cases of elevat- 14 PATIENT CARE ENDOCRINOLOGY & CARDIOLOGY www.patientcareonline.com http://www.patientcareonline.com

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Patient Care - Endocrinology & Cardiology - October 2007 Research Digest Contents Medicine in the News Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes Using Troponins to Evaluate Cardiac Injury The 15-Minute Visit Classified Advertising Clinical Clips

Patient Care Endocrinology & Cardiology - October 2007

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