Development of Diabetes in Chinese With the Metabolic Syndrome

Abstract

OBJECTIVE -We investigated the association of the metabolic syndrome with new-onset diabetes in the Hong Kong Cardiovascular Risk Factor Prevalence Study cohort.RESEARCH DESIGN AND METHODS -We followed up on 1,679 subjects without diabetes at baseline. Those with a previous diagnosis of diabetes or those who were receiving drug treatment were considered to be diabetic. The remaining subjects underwent a 75-g oral glucose tolerance test (OGTT). Diabetes was defined by plasma glucose Ն7.0 mmol/l with fasting and/or Ն11.1 mmol/l at 2 h.RESULTS -The prevalences of the metabolic syndrome at baseline were 14.5 and 11.4%, respectively, according to U.S. National Cholesterol Education Program (NCEP) and International Diabetes Federation (IDF) criteria. After a median of 6.4 years, there were 66 and 54 new cases of diabetes in men and women, respectively. The metabolic syndrome at baseline predicted incident diabetes. Hazard ratios (HRs) for the NCEP and IDF definitions of the syndrome were 4.1 [95% CI 2.8 -6.0] and 3.5 [2.3-5.2], respectively. HRs for fasting plasma glucose (FPG) Ն6.1 or 5.6 mmol/l were 6.9 [4.1-11.5] and 4.1 [2.8 -6.0], respectively. The NCEP and IDF criteria had 41.9 and 31.7% sensitivity and 87.5 and 90.2% specificity, respectively. Their positive predictive values were low, ϳ20%, but their negative predictive values were ϳ95%.CONCLUSIONS -The metabolic syndrome, particularly its component, elevated FPG, predicts diabetes in Chinese. An individual without the metabolic syndrome is unlikely to develop diabetes, but one who has it should practice therapeutic lifestyle changes and have periodic FPG measurements to detect new-onset diabetes. Diabetes Care 30:1430-1436, 2007T he metabolic syndrome has been promoted as a clinical tool for identifying individuals predisposed to diabetes and/or adverse cardiovascular outcomes (1-7). Attempts have been made by different consensus groups to produce diagnostic criteria for the syndrome, but there is still some controversy. The pathogenetic mechanism underlying the metabolic syndrome remains uncertain, although central obesity and insulin resistance have been proposed to play a causative role. Because insulin resistance, together with hyperinsulinemia, is a fundamental metabolic abnormality in type 2 diabetes, the metabolic syndrome may be expected to be a good predictor of the development of the latter. Asians are thought to have a higher body fat percentage and cardiovascular risks than Caucasians at a given BMI (8). These factors raise concerns that definitions of the metabolic syndrome for Caucasians, when applied to Asian populations, would underestimate the population at risk of developing adverse outcomes such as type 2 diabetes, cardiovascular disease, and mortality. Therefore, validation of the predictive value of the metabolic syndrome needs to be established in population-based cohorts of different ethnicities. The International Diabetes Federation (IDF) proposed a new definition of the metabolic syndrome, which uses ethnicspecific central obesity cri...

A single nucleotide polymorphism in APOA5 determines triglyceride levels in Hong Kong and Guangzhou Chinese

“…[8][9][10] These subjects were first recruited from the general population in 1995-1996 and were examined again in CRISPS-2 in 2000-2004 after a median interval of 6.4 years. The study protocol was approved by the Ethics Committee of the University of Hong Kong.…”

Association of genetic variants in the adiponectin gene with adiponectin level and hypertension in Hong Kong Chinese

“…The Hong Kong CRISPS was a cohort study of cardiovascular risk factors in the Hong Kong Chinese (16,17). Of the 2895 subjects who initially participated (CRISPS-1), 1944 enrolled in the follow-up study (CRISPS-2) in 2000-2004 after a median interval of 6.4 years.…”

Association of the FABP2 Ala54Thr polymorphism with type 2 diabetes, obesity, and metabolic syndrome: a population-based case-control study and a systematic meta-analysis

“…MetS has become a global health concern over the past few decades. Individuals with MetS have a two-fold higher risk of mortality and a three-fold higher risk of experiencing a cardiovascular event, compared with those without MetS (Cheung et al, 2007). The etiology of MetS is highly complex; both genetic and environmental factors are thought to play an important role.…”