Pre-diabetes and Metabolic Syndrome in Germans

There has been an ongoing discussion as to which clinical condition can be described as ”prediabetes” or as ”metabolic syndrome” [1]. Both conditions are known to have the same risk factors, but the association between the two conditions remains unclear [2].

We were able to confirm the findings of Kanauchi et al. [3] for the German population. Oral glucose tolerance tests were performed in 686 persons (53.8 ± 7.9 years) at increased risk for diabetes mellitus. Three hundred and forty-six were diagnosed with normal glucose tolerance (NGT), 252 with prediabetes and 88 with type 2 diabetes (T2D). 16.8 % of the participants in the NGT group had the metabolic syndrome, 50.3 % in the prediabetes group and 64.7 % in the T2D group according to ATP_III criteria. The best metabolic syndrome parameters for predicting prediabetes were fasting glucose OR = 5,43 (2.04 - 13.1), p < 0.001, waist circumference OR = 2.30 (1.16 - 3.30), p < 0.001 and triglycerides OR = 2.38 (1.77 - 3.77), p = 0.01. Blood pressure as well as HDL did not show a significant association with the prediction of prediabetes maybe due to age dependency [4]. Insulin resistance was significantly higher in persons with prediabetes (p < 0.001). Furthermore, utilization of free fatty acids (represented as area under the curve for free fatty acids) was significantly higher in prediabetic persons (p < 0.001).

We therefore conclude that prediabetes and the metabolic syndrome often coexist also in the German Caucasian population. Visceral obesity and insulin resistance are major underlying parameters [5]. To prevent the metabolic syndrome and prediabetes, these risk factors should be diagnosed and treated early. Waist circumference representing visceral obesity is an easy screening and follow-up parameter.

References

• 1 Schriger D L, Lorber B. Lowering the cut point for impaired fasting glucose: where is the evidence? Where is the logic?.  Diabetes Care. 2004;  27 592-601
• 2 Kahn R. et al . The metabolic syndrome: time for a critical appraisal. Joint statement from the American Diabetes Association and the European Association for the Study of Diabetes.  Diabetologia. 2005;  48 1684-1699
• 3 Kanauchi M. et al . New ”pre-diabetes” category and the metabolic syndrome in Japanese.  Horm Metab Res. 2005;  37 622-626
• 4 Schutte A E, O'Dea K, Schwarz P E. Could statistical adjustments for age mask the insulin-blood pressure relationship?.  Diabetes Res Clin Pract. 2006;  72 104-107
• 5 Haffner S M. et al . Decreased insulin secretion and increased insulin resistance are independently related to the 7-year risk of NIDDM in Mexican-Americans.  Diabetes. 1995;  44 1386-1391