Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance

Authors

H. Florez, University of Miami
M. Temprosa, The Biostatistics Center, George Washington UniversityFollow
Trevor J. Orchard, University of PittsburghFollow
Kieren J. Mather, Indiana UniversityFollow
Santica M. Marcovina, Northwest Lipid Research LaboratoriesFollow
Elizabeth Barrett-Connor, University of California, San Diego
Edward Horton, Harvard Medical SchoolFollow
C. D. Saudek, Johns Hopkins University
F. X. Pi-Sunyer, Columbia University
R. E. Ratner, Medstar Health Research Institute, Baltimore, MD
R. B. Goldberg, University of MiamiFollow

Document Type

Journal Article

Publication Date

4-2014

Journal

Diabetes, Obesity and Metabolism

Volume

Volume 16, Issue 4

Inclusive Pages

326-333

Abstract

Aims

To determine the association of metabolic syndrome (MetS) and its components with diabetes risk in participants with impaired glucose tolerance (IGT), and whether intervention-related changes in MetS lead to differences in diabetes incidence.

Methods

We used the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) revised MetS definition at baseline and intervention-related changes of its components to predict incident diabetes using Cox models in 3234 Diabetes Prevention Program (DPP) participants with IGT over an average follow-up of 3.2 years.

Results

In an intention-to-treat analysis, the demographic-adjusted hazard ratios (95% confidence interval) for diabetes in those with MetS (vs. no MetS) at baseline were 1.7 (1.3–2.3), 1.7 (1.2–2.3) and 2.0 (1.3–3.0) for placebo, metformin and lifestyle groups, respectively. Higher levels of fasting plasma glucose and triglycerides at baseline were independently associated with increased risk of diabetes. Greater waist circumference (WC) was associated with higher risk in placebo and lifestyle groups, but not in the metformin group. In a multivariate model, favourable changes in WC (placebo and lifestyle) and high-density lipoprotein cholesterol (placebo and metformin) contributed to reduced diabetes risk.

Conclusions

MetS and some of its components are associated with increased diabetes incidence in persons with IGT in a manner that differed according to DPP intervention. After hyperglycaemia, the most predictive factors for diabetes were baseline hypertriglyceridaemia and both baseline and lifestyle-associated changes in WC. Targeting these cardiometabolic risk factors may help to assess the benefits of interventions that reduce diabetes incidence.

Comments

This article is a U.S. Government work and is in the public domain in the USA.

APA Citation

Florez, H., Temprosa, M.G., Orchard, T.J., Mather, K.J., Marcovina, S.M. et al. (2014). Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance. Diabetes, Obesity and Metabolism, 16(4), 326-333.

Open Access

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