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Complications of Diabetes

Do you have the Metabolic Syndrome?

Introduction

The International Diabetes Federation recently issued (April 2005) a new definition of the Metabolic Syndrome. This definition is based on three out of five factors

  1. waist circumference
  2. triglyceride concentrations
  3. HDL cholesterol concentrations
  4. blood pressure
  5. fasting plasma glucose

According to the new IDF definition, for a person to be defined as having the metabolic sydrome they must have:

Central obesity, defined as waist circumference greater or equal to 94 cm (about 38 inches) for Europid men and greater or equal to 80 cm (32 inches) for Europid women, with ethnicity specific values for other groups.

Plus any two of the following four factors:

  • raised triglyceride level : > 1.7 mmol/l (150 mg/dl)  or specific treatment for this lipid abnormality
  • reduced HDL cholesterol <1.0 mmol/l in males and < 1.3 mmol/l in females, or specific treatment for this lipid abnormality
  • raised blood pressure: systolic BP > 130 or diastolic BP > 85 mmHg, or treatment of previously

What is the Metabolic Syndrome?

The metabolic syndrome is a cluster of potent risk factors for having heart attacks.

These include

  • diabetes or prediabetes
  • abdominal obesity
  • abnormal lipid levels in the blood
  • high blood pressure

People who have the metabolic syndrome are three to five times as likely to have a heart attack or stroke when compared to people who do not have the syndrome. They also have a five-fold increased risk of developing type 2 diabetes if they have not already done so.

Why do people develop the metabolic syndrome?

This is probably due to a combination of genetic predisposition and lifestyle factors. The mechanisms surrounding this condition are complex, though a high fat diet and physical inactivity are thought to be key contributors.

What is the link with insulin resistance?

Many previous definitions of the metabolic syndrome include mention of insulin resistance. Insulin resistance is undoubtedly a manifestation of the metabolic syndrome, however it is difficult to measure. Having raised blood sugars or type 2 diabetes in the presence of the other risk factors implies the presence of insulin resistance.

What is the significance of this new definition?

Between 10 and 25% of men and women in Europe are obese. It is estimated that over 30 million people across Europe will require treatment for diabetes by the year 2010. Many of these people will have features of the metabolic syndrome. The rising costs of type 2 diabetes is now recognised as a major healthcare and social issue and has often been referred to a a ‘time-bomb’ in the developed world. This new definition will help identify such people and health professionals will be able to target their risk factors, thereby reducing their risk of heart attacks and stroke as well as the risk of developing type 2 diabetes.

How can I reduce my risk?

Reducing your risk may require attention to several risk factors. Weight loss and increased exercise are probably the most effective ways of dealing with this condition. The following aspects are addressed in more detail elsewhere on the DiabeteSuffolk website.

  • increase physical activity
  • develop better eating habits
  • stop smoking
  • take medication to lower blood pressure if necessary

How can public health initiatives help cope with this problem?

Changing dietary habits and by replacing foods which are high in saturated fats with those high in unsaturated fats.

Is it just adults who are affected?

No. This condition is increasingly diagnosed in children and adolescents due to the increase in obesity seen in younger age groups. Studies have shown that obese children are frequently insulin resistant, which places them at heightened risk of developing type 2 diabetes.

How is the Metabolic syndrome treated?

This topic is addressed in a separate document.

 

Dr Nishan Wijenaike MD, FRCP
Consultant Diabetologist
West Suffolk Hospital NHS Trust
Bury St Edmunds
June 2005