Risk factors associated with metabolic syndrome in type 2 diabetes mellitus patients according to World Health Organization, Third Report National Cholesterol Education Program, and International Diabetes Federation definitions

Angel Rodríguez¹, Helena Delgado-Cohen¹, Jesús Reviriego¹, Manuel Serrano-Ríos^2
1Clinical Research Department, Eli Lilly and Company, Madrid, Spain; ²Department of Internal Medicine II, Hospital Clinico San Carlos, Madrid, Spain

Background: The availability of several definitions of the metabolic syndrome has created potential confusion concerning its prognostic utility. At present, little data exist about the risk factors associated with metabolic syndrome in diabetic patients.
Aim: To identify risk factors associated with metabolic syndrome in patients with type 2 diabetes mellitus according to three diagnostic criteria: World Health Organization (WHO), Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults – Adult Treatment Panel III (NCEP-ATP III), and International Diabetes Federation (IDF).
Subjects and methods: A logistic regression model was used to identify demographic, clinical, and lifestyle variables related with metabolic syndrome (N = 1259).
Results: Hypertension, dyslipidemia, and glycosylated hemoglobin (HbA_1c) ≥7% were associated with increased risk of WHO-defined metabolic syndrome (odds ratio [OR], 2.33; 95% confidence interval [CI]: 1.60–3.40; OR, 1.79 95% CI: 1.25–2.55; and OR, 1.58; 95% CI: 1.12–2.22, respectively). The risk of presenting metabolic syndrome according to NCEP-ATP III criteria was increased in female patients (OR, 2.02; 95% CI: 1.37–2.97), elevated fasting glucose levels (OR, 5.99; 95% CI: 3.56–10.07), dyslipidemia (OR, 2.28; 95% CI: 1.57–3.32), hypertension (OR, 2.36; 95% CI: 1.59–3.53), and endocrine disorders (OR, 1.64; 95% CI: 1.06–2.57). For the IDF criteria, female patients and patients with left ventricular hypertrophy or insulin treatment were at higher risk of metabolic syndrome (OR, 4.00; 95% CI: 2.35–6.80; OR, 2.72 95% CI: 1.22–6.04; and OR, 1.96 95% CI: 1.24–3.11, respectively).
Conclusions: The risk factors for metabolic syndrome in type 2 diabetes mellitus patients are highly dependent on the criteria used to define the syndrome, supporting the need for a single clinically useful and epidemiologically useful definition.

Keywords: metabolic syndrome, type 2 diabetes mellitus, epidemiologic studies, risk factors