The Metabolic Syndrome Is a Risk Indicator of Microvascular and Macrovascular Complications in Diabetes

Abstract

Results from Metascreen, a multicenter diabetes clinic-based survey THE METASCREEN WRITING COMMITTEE* OBJECTIVE -We aimed at assessing the degree of association and the predictive power of the metabolic syndrome with regard to clinically detectable complications in patients with diabetes.RESEARCH DESIGN AND METHODS -Metascreen is a cross-sectional survey of metabolic syndrome and clinically detected diabetes complications performed in 8,497 patients (7,859 with type 2 diabetes and 638 with type 1 diabetes) randomly chosen in 176 diabetes outpatient clinics throughout Italy. The metabolic syndrome was defined according to either the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) or the International Diabetes Federation (IDF) diagnostic criteria. Multivariate analyses of the association(s) between either AHA/NHLBI or IDF metabolic syndrome and clinical complications were performed. Receiver-operator characteristic (ROC) curves were constructed to compare the predictive power of the two sets of diagnostic criteria of the metabolic syndrome.RESULTS -Either definition of the metabolic syndrome was an independent statistical indicator of the presence of nephropathy and neuropathy (P Ͻ 0.02-0.01) in type 1 diabetes and of all complications (P Ͻ 0.0001), including cardiovascular disease and retinopathy, in type 2 diabetes. For each complication, the ROC curves based on either AHA/NHLBI or IDF metabolic syndrome were similar to each other and to the ROC curves constructed with all continuous traits compounding the metabolic syndrome.CONCLUSIONS -The metabolic syndrome, defined according to AHA/NHLBI or IDF diagnostic criteria, is an independent clinical indicator and may be involved in the pathogenesis of both macro-and microvascular complications of diabetes. Diabetes Care

Vascular Disease in the Metabolic Syndrome: Do We Need to Target the Microcirculation to Treat Large Vessel Disease?

“…This appears to be in accordance with a number of observational studies that suggest that patients who have the metabolic syndrome in concert with type 2 diabetes have a higher frequency of microvascular complications [38,39,40]. In the large Metascreen study conducted in Italy, for example, the metabolic syndrome was independently associated with both macro- and microvascular complications of diabetes [41]. However, not all studies have confirmed this association, a notable exception being the UKPDS [42].…”

The impact of metabolic syndrome on retinal findings in patients with erectile dysfunction

“…[27] A number of studies have demonstrated MS to be associated with macrovascular and microvascular complications. [23,28] Cuspidi et al [28] investigated the prevalence of MS in patients with vascular, cardiac and renal organ damage by utilizing the NCEP criteria. They established the prevalence of MS in patients with three-organ damage to be 2.3 times as high as that in patients without organ damage.…”

“…The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) revealed that the prevalence of any retinopathy was 8% at 3 years and 25% at 5 years. [22] Studies have demonstrated that diabetic patients with MS experienced microvascular complications earlier and more often compared with diabetic patients without MS. [23][24][25][26] Diabetes is known to induce endothelial dysfunction and is a major risk factor leading to microangiopathy. Other MS criteria have also been reported to increase endothelial dysfunction and thus accelerate the inflammatory process.…”

Diabetes and obesity are the main metabolic drivers of peripheral neuropathy

“…Multiple studies have implicated the metabolic syndrome (MetS) as a potential cause of peripheral neuropathy 11, 12, 13, 14. However, studies that have investigated the contributions of the individual components have revealed mixed results 15, 16, 17, 18, 19, 20, 21.…”