Abstract              Background: The metabolic syndrome (MS) is described as clusters of abnormalities including abdominal obesity, insulin resistance, hypertension, hyperglycaemia, increased triglycerides, and decreased high-density lipoprotein cholesterol (HDL-C). Material and Method: All the patients aged > 18 years with newly detected Type 2 Diabetes Mellitus (< 6 months duration) admitted in Krishna institute of Medical Sciences. Classifying patients in four groups as (1) NCEP - ATP III, (2) Modified NCEP ATP III, (3) Modified WHO, (4)IDF - Presence of Central Obesity with waist circumference > 90 cm men and > 80 cm. Sample size: 100 patients. Results: Modified NCEP ATP III predicted MS in 60 patients (70%) and IDF criteria predicted MS in 40 (46%) patients which is least compared to others. Modified WHO and NCEP ATP III criteria’s were predicting MS 55(64%), 48(56%) respectively. Mean age of male is 47.23±9.82, mean age of female is 49.68±10.71, mean age of all cases is 48.60±10.48 comparing this age among male and female Z = 1.10, p>0.05.Mean and S.D of age (male) is 48.1±10.23. Mean and S.D of age (female) is 49.63±11.2. Mean age of all patients is 49.15 comparing this age among male and female Z - 0.53, p>0.05.By analyzing various individual parameters of MS in newly detected DM patients, high Triglycerides were present in 68(79%) patients(male-39,female-29) followed by raised SBP in 58(67.4%) patients(male-29, female-29). High fasting blood glucose was present in 55 patients, low HDL in 53 patients. Significant WC, waist hip ratio and significant BMI was seen in 44,40 and 40 patients respectively Conclusion: Modified NCEP ATP III criteria predicts highest occurrence of MS in newly detected type 2 DM patients. Elevated serum TG for men and decreased HDL for women were strongest single predictors, effectively indicating the presence of MS in newly detected type 2 DM patients.

Key Words: Diabetes mellitus type2, duration of diabetes, metabolic syndrome.

 

INTRODUCTION

The metabolic syndrome (MS) is described as clusters of abnormalities including abdominal obesity, insulin resistance, hypertension, hyperglycaemia, increased triglycerides, and decreased high-density lipoprotein cholesterol (HDL-C)¹. The number of people with the metabolic syndrome also differs by sex, race, and ethnicity. Most patients with diabetes have metabolic syndrome with estimated prevalence of 69.9 per cent for Whites, 64.8 per cent for Blacks, and 62.4 per cent for Mexican Americans. Type 2 diabetes mellitus (T2DM) is a significant risk factor for coronary artery disease (CAD) and stroke¹. At least 65 per cent of people with T2DM die of some form of heart disease and stroke². Patients with T2DM have an increased prevalence of lipid abnormalities, which contribute to higher rates of CAD. High triglyceride and low HDL cholesterol levels were significantly related to all coronary heart disease events and to coronary mortality in patients with T2DM³. Moreover, the prevalence of CAD in diabetes patients increases significantly with the addition of MS components⁴. According to Third National Health and Nutrition Examination Survey (NHANES III) data, people who did not have MS, had the lowest risk for cardiovascular disease (CVD) events, those with MS had an intermediate level of risk, and those with diabetes had the highest level of risk ⁵

 

MATERIALS AND METHODS

Source of data: All the patients aged > 18 years with newly detected Type 2 Diabetes Mellitus (< 6 months duration) admitted in Krishna institute of Medical Sciences.

Methods of collection of data: (including sampling procedure) Informed and written consent was obtained from all the participants after explaining the procedure. The study protocol was approved by the Institute's Ethics Committee. Initial evaluation included a detailed history and clinical examination to exclude any systemic disease. Classifying patients in four groups as

NCEP - ATP III Presence of > 3 of following

1. Waist circumference > 102 cm in men, > 88 cm in women
2. SBP > 130 mm Hg and or DBP > 85 mm Hg
3. TG > 150 mg/dl (1.7 mmol/l.)
4. HDL < 40 mg/dl in men, < 50 mg/dl in women
5. Fasting glucose > 110 mg/dl.

Modified NCEP ATP III - Presence of > 3 of the following

1. Waist circumference > 90 cm in men, > 80 cm in women
2. SBP > 130 mm Hg and or DBP > 85 mm Hg
3. TG > 150 mg/dl
4. HDL               C < 40 mg/dl in men < 50 mg/dl in women
5. Fasting glucose > 110 mg/dl

Modified WHO - Presence of diabetes and > 2 of the following

1. BMI > 30 kg/m² or WHR >.9 in men, >.85 in women
2. TG > 150mg/dl or HDL-C < 35 mg/dl in men < 39 mg/dl in women
3. BP > 140/90 mm Hg

IDF - Presence of Central Obesity with waist circumference > 90 cm men and > 80 cm in women plus any 2 of following

1. TG > 150 mg/dl
2. HDL-C < 40 mg in men, < 50 mg/dl in women
3. SBP > 130 mm Hg and or DBP > 85 mm Hg
4. Fasting plasma glucose > 100 mg/dl.

Inclusion Criteria

1. Type 2 Diabetes Mellitus detected < 6 months both sexes
2. Age 18 years and above

Sample size: 100 patients

Exclusion Criteria:

1. Type 2 Diabetes Mellitus > 6 months
2. Age below 18 years
3. Type 1 Diabetes Mellitus
4. Gestational Diabetes mellitus

 

Mode of Collection:

1. Simple random method
2. Sample size- 100 patients
3. Duration of study-2yrs

 

OBSERVATIONS AND RESULTS

 

Table 1: Patients predicting MS based on different criteria

 

Figure 1: Patients predicting MS based on different criteria

 

By considering different criteria's for metabolic syndrome results showed that modified NCEP ATP III predicted maximum number of Metabolic Syndrome in newly detected diabetes when compared to other criteria. Modified NCEP ATP III predicted MS in 60 patients (70%) and IDF criteria predicted MS in 40 (46%) patients which is least compared to others. Modified WHO and NCEP ATP III criterias were predicting MS 55 (64%), 48 (56%) respectively.

 

Table 2: DM detection at different age group

Figure 2: DM detection at different age group

 

Respect to age consideration, 45 patients were in the age group of 30- 49 yrs, 36 patients in 50-59 yrs, 12 patients in 60-69 yrs and 7 patients in more than 70 years. Mean and S.D of age (male) is 48.1±10.23. Mean and S.D of age (female) is 49.63±11.2. Mean age of all patients is 49.15 comparing this age among male and female Z - 0.53, p>0.05.

 

Table 3: Predicting MS at different age group

 

Figure 3: Predicting MS at different age group

 

In the age group 30-49 yrs, 38 patients (44%) were predicting MS and 6 patients (7%) were predicting MS more than 70 years. 33 patients (38.4%) and 9 patients (10.5%) were in the group 50-59 years and 60-69 years respectively predicting MS. Our study showed more number of newly detected diabetes predicting MS were 30-49 years and least in more than 70 years. Mean age of male is 47.23±9.82, mean age of female is 49.68±10.71, mean age of all cases is 48.60±10.48. comparing this age among male and female Z = 1.10, p>0.05.

 

Table 4: Duration of DM

 

Table 5: Various single parameters predictors of metabolic syndrome

By analyzing various individual parameters of MS in newly detected DM patients, high Triglycerides were present in 68(79%) patients(male-39,female-29) followed by raised SBP in 58(67.4%) patients(male-29, female-29). High fasting blood glucose was present in 55 patients, low HDL in 53 patients. Significant WC, waist hip ratio and significant BMI was seen in 44,40 and 40 patients respectively.

 

DISCUSSION

In our study 100 pts of newly detected diabetes mellitus were included, among these 18 patients were detected as newly DM, at the time of admission, 28 patients had 1-3 months history of DM and 54 patients had 4-6 months history of DM. Among 100 newly detected DM patients 42 (42%) were males and 58 (58%) were females.

 

Table 6: Comparative studies predicting MS

Our study showed prevalence of metabolic syndrome varying from 46.95% (IDF), to 69.76 % (Modified NCEP ATPIII), by different criteria, in newly detected DM type 2 individuals. Prevalence of MS was 55.81% and 63.95 % according to NCEP ATP III, and modified WHO respectively. Study conducted by Ethiraj Dhanraj et al, showed prevalence of patients predicting MS in newly detected DM -type 2 was 64.47%, 56.83%, 67.85%, 62.34% according to modified WHO, NCEP ATP III, modified NCEP ATP III, IDF respectively. Almost similar percent of patients predicting MS seen in this study except the variation result was seen in IDF criteria. Carole et al, study using modified WHO,, NCEP ATP III and IDF criteria showed 38 %, 61%, and 54 % respectively. Thus comparing this study results were almost equal in respective NCEP ATP III, and IDF criteria. But difference was seen with modified WHO criteria. Charles et al study was predicting 43.5 % of MS according to NCEP ATP III criteria in newly detected type 2 DM where as our study is predicting 55.81% of patients. Caroles et al study was predicting less number of MS in newly detected DM patients according to modified WHO (41.3%), NCEP ATP 111(48.7%) criteria, when compared to our study with the same criteria.