JDM  Vol.2 No.3 , August 2012
Metabolic syndrome and its individual components among people with type 2 diabetes: Prevalence, gender differences and its association with ischemic heart disease
Abstract: Background: Metabolic syndrome (MS) is common among people with type 2 diabetes. The purpose of this study was to assess the proportion of MS and its individual components among type 2 diabetic adults, to stratify these by gender and to determine their association with ischemic heart disease (IHD). Method: A cross-sectional multicentre study was conducted in public and private sector clinics in Karachi, Pakistan. A pretested structured questionnaire and medical records were used to collect information from 889 people with type 2 diabetes after informed consent. Chi-square test and odds ratios with 95% CI were used to assess the association of MS, its components and IHD. Adjusted odds ratios were used to evaluate the differences of MS and its components by gender. Results: In all, 70% of the participants had MS. The likelihood of having IHD among those with MS was higher (OR = 3.21; 95%CI = 2.22 - 4.65). Of the individual MS components, obesity conferred the strongest association with IHD (OR = 2.57; 95%CI = 1.91 - 3.43). Multivariate analysis showed an increased proportion of MS among women (AOR = 1.63; 95%CI = 1.18 - 2.24). Of the individual MS components, women had a higher prevalence of obesity (AOR = 4.70; 95%CI = 3.30 - 6.70). Conclusion: A very high burden of MS among type 2 diabetics has been identified in this study. Dedicated interventions are needed to prevent/delay the onset of MS and the associated morbidity and mortality.
Cite this paper: Khan Khuwaja, A. , Nawaz Ali, F. , Naqvi, I. , Bux, R. , Jabbar, A. and Hassan Dhanani, R. (2012) Metabolic syndrome and its individual components among people with type 2 diabetes: Prevalence, gender differences and its association with ischemic heart disease. Journal of Diabetes Mellitus, 2, 332-337. doi: 10.4236/jdm.2012.23052.

[1]   Shaw, J.E., Sicree, R.A. and Zimmet, P.Z. (2010) Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Research and Clinical Practice, 87, 4-14. doi:10.1016/j.diabres.2009.10.007

[2]   Shera, A.S., Basit, A., Fawwad, A., Hakeem, R., Ahmedani, M.Y., Hydrie, M.Z. and Khwaja, I.A. (2010) Pakistan National Diabetes Survey: Prevalence of glucose intolerance and associated factors in the Punjab Province of Pakistan. Primary Care Diabetes, 4, 79-83. doi:10.1016/j.pcd.2010.01.003

[3]   Khuwaja, A.K., Rafique, G., Azam, I. and White, F. (2004) Macrovascular complications and their associated factors among persons with type 2 diabetes in Karachi, Pakistan —A multi-centre study. Journal of Pakistan Medical Association, 54, 60-66.

[4]   Coccheri, S. (2007) Approaches to prevention of cardiovascular complications and events in diabetes mellitus. Drugs, 67, 997-1026. doi:10.2165/00003495-200767070-00005

[5]   Hoerger, T.J. and Ahmann, A.J. (2008) The impact of diabetes and associated cardiometabolic risk factors on members: Strategies for optimizing outcomes. Journal of Managed Care Pharmacy, 14, 2-14.

[6]   Khuwaja, A.K., Khowaja, L.A. and Cosgrove, P. (2010) The economic costs of diabetes in developing countries: Some concerns and recommendations. Diabetologia, 53, 89-90. doi:10.1007/s00125-009-1581-7

[7]   Roaeid, R.B. and Kablan, A.A. (2010) Diabetes mortality and causes of death in Benghazi: A 5-year retrospective analysis of death certificates. Eastern Mediterranean Health Journal, 16, 65-69.

[8]   American Diabetes Association (ADA) (2009) Standards of Medical Care in Diabetes 2009. Diabetes Care, 32, S13-S61. doi:10.2337/dc09-S013

[9]   Khuwaja, A.K. (2005) Microalbuminuria among patients with type 2 diabetes mellitus: Early screening and intervention required. Hong Kong Medical Journal, 11, 70.

[10]   Tong, P.C., Kong, A.P., So, W.Y., Yang, X., Ho, C.S., Ma, R.C., Ozaki, R., Chow, C.C., Lam, C.W., Chan, J.C. and Cockram, C.S. (2007) The usefulness of the International Diabetes Federation and the National Cholesterol Education Program’s Adult 10 Treatment Panel III definitions of the metabolic syndrome in predicting coronary heart disease in subjects with type 2 diabetes. Diabetes Care, 30, 1206-1211. doi:10.2337/dc06-1484

[11]   Koehler, C., Ott, P., Benke, I. and Hanefeld, M. (2007) Comparison of the prevalence of the metabolic syndrome by WHO, AHA/NHLBI, and IDF definitions in a German population with type 2 diabetes: The Diabetes in Germany (DIG) Study. Hormone and Metabolic Research, 39, 632-635. doi:10.1055/s-2007-985816

[12]   Ahmed, S., Ahmed, S.A. and Ali, N. (2010) Frequency of metabolic syndrome in type 2 diabetes and its relationship with insulin resistance. Journal of Ayub Medical College, 22, 22-27.

[13]   Ahmed, N., Ahmad, T., Hussain, S.J. and Javed, M. (2010) Frequency of metabolic syndrome in patients with type-2 diabetes. Journal of Ayub Medical College, 22, 139-142.

[14]   de Simone, G., Devereux, R.B., Chinali, M., Best, L.G., Lee, E.T., Galloway, J.M. and Resnick, H.E. (2007) Strong Heart Study Investigators. Prognostic impact of metabolic syndrome by different definitions in a population with high prevalence of obesity and diabetes: The strong heart study. Diabetes Care, 30, 1851-1856. doi:10.2337/dc06-2152

[15]   Song, S.H. and Hardisty, C.A. (2008) Diagnosing metabolic syndrome in type 2 diabetes: Does it matter? QJM, 101, 487-491. doi:10.1093/qjmed/hcn034

[16]   Jafar, T.H., Qadri, Z. and Chaturvedi, N. (2008) Coronary artery disease epidemic in Pakistan: More electrocardiographic evidence of ischaemia in women than in men. Heart, 94, 408-413. doi:10.1136/hrt.2007.120774

[17]   Jafar, T.H. (2006) Women in Pakistan have a greater burden of clinical cardiovascular risk factors than men. International Journal of Cardiology, 106, 348-354.

[18]   Njelekela, M.A., Mpembeni, R., Muhihi, A., Mligiliche, N.L., Spiegelman, D., Hertzmark, E., Liu, E., Finkelstein, J.L., Fawzi, W.W., Willett, W.C. and Mtabaji, J. (2009) Gender-related differences in the prevalence of cardiovascular disease risk factors and their correlates in urban Tanzania. BMC Cardiovascular Disorders, 17, 30. doi:10.1186/1471-2261-9-30

[19]   Khuwaja, A.K. and Kadir, M.M. (2010) Gender differences and clustering pattern of behavioural risk factors for chronic noncommunicable diseases: community- based study from a developing country. Chronic Illness, 6, 163-170. doi:10.1177/1742395309352255

[20]   World Health Organization (WHO) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus. WHO, Geneva, 1999.

[21]   World Health Organization (2011) Media Centre: Diabetes.

[22]   Mohan, V., Deepa, R., Rani, S.S. and Premalatha, G. (2001) Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India: The Chennai Urban Population Study (CUPS No. 5). Journal of American College of Cardiology, 38, 682-687. doi:10.1016/S0735-1097(01)01415-2

[23]   Janghorbani, M., Amini, M. and Tavassoli, A. (2006) Coronary heart disease in type 2 diabetes mellitus in Isfahan, Iran: prevalence and risk factors. Acta Cardiologica, 61, 13-20. doi:10.2143/AC.61.1.2005135

[24]   Harris, S.B., Naqshbandi, M., Bhattacharyya, O., Hanley, A.J., Esler, J.G. and Zinman, B. (2011) Major gaps in diabetes clinical care among Canada’s First Nations: Results of the CIRCLE study. Diabetes Research and Clinical Practice, 92, 272-279. doi:10.1016/j.diabres.2011.02.006

[25]   DAI Study Group (2004) The prevalence of coronary heart disease in type 2 diabetic patients in Italy: The DAI study. Diabetic Medicine, 21, 738-745. doi:10.1111/j.1464-5491.2004.01230.x

[26]   Deepa, R., Sandeep, S. and Mohan, V. (2006) Abdominal obesity, visceral fat and type 2 diabetes—Asian Indian phenotype. In: Mohan, V. and Rao, G.H.R., Eds., Type 2 diabetes in South Asians: Epidemiology, risk factors and prevention. Jaypee Brothers Medical Publishers Ltd., New Delhi, 138-152.

[27]   Hwang, I.C., Kim, K.K., Jee, S.H. and Kang, H.C. (2011) A comparison of predictability of cardiovascular events between each metabolic component in patients with metabolic syndrome based on the revised national cholesterol education program criteria. Yonsei Medical Journal, 52, 220-226. doi:10.3349/ymj.2011.52.2.220

[28]   Bosevski, M., Pemovska, G., Bosevska, G. and Georgievska-Ismail, L. (2010) Clinical role of estimation metabolic syndrome’s components in type 2 diabetic population with symptomatic coronary artery disease—A comparison of two criteria. Medicinski Arhiv, 64, 144-146.

[29]   Doi, Y., Ninomiya, T., Hata, J., Yonemoto, K., Arima, H., Kubo, M., Tanizaki, Y., Iwase, M., Iida, M. and Kiyohara, Y. (2009) Proposed criteria for metabolic syndrome in Japanese based on prospective evidence: The Hisayama study. Stroke, 40, 1187-1194. doi:10.1161/STROKEAHA.108.531319

[30]   Ford, E.S., Li, C. and Zhao, G. (2010) Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US. Journal of Diabetes, 2, 180-193. doi:10.1161/STROKEAHA.108.531319