Prevalence
of Metabolic Syndrome among Patients with Type
2 Diabetes in Aden Governorate
.........................................................................................................................
Abdullah Mohamed Ahmed PhD1, Salem Bin Selm
PhD2
1- Associated prof. Internal Medicine Dept.Faculty
of Medicine Aden University Yemen
2- Associated professor. Internal Medicine,
faculty of Medicine. Aden University, Yemen
Correspondence:
Abdulla Mohammed Ahmed Almatary PhD.
Associated prof. Internal medicine dept.
Faculty of medicine Aden University Yemen
PO Box 5184 Malla Aden
Mobile: +967 733410777
E-mail: dramaalmatary@hotmail.com
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ABSTRACT
Background:
Metabolic syndrome (MS) (cardiometabolic
risk) is a cluster of risk factors that
is responsible for much of the excess
cardiovascular disease. The components
of MS vary according to the definition
followed such as: the presence of three
metabolic abnormalities from these factors,
hypertension, dyslipidemia, obesity and
type2 diabetes.
Objectives:
This study is a retrospective study to
determine the prevalence of metabolic
syndrome (MS) among type 2 diabetic patients
who attended my private diabetic clinic
in Aden Governorate during 2005-2006.
Methods:
The total number of patients records reviewed
were 460 (males=260 and females=200).
The diagnosis of MS applied was according
to WHO criteria, which is the presence
of hypertension, obesity and type 2 diabetes.
The duration of diabetes recorded ranged
from a few days to 20 years, and age range
was 39-75 with mean age (57 years).
The results indicate
that the total number of patients who
have MS are 139/460, with overall prevalence
rate of 32.2 %. The males were 65/260
(25%) and females were 74/200 (37%). The
prevalence of each component of MS among
the study patients with type 2 diabetes
are, hypertension 50.9 % and obesity 25.4%.
Conclusion: Metabolic syndrome is considerably
high among our diabetic patients who therefore
they are more vulnerable to cardiovascular
diseases and a call for more health care
of diabetics.
Key words:
Metabolic syndrome, type2 diabetes, Aden
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Metabolic syndrome (MS),
also called insulin resistance syndrome or syndrome
X(1), is a cluster of risk factors that is
responsible for much of the excess cardiovascular
disease (CVD) morbidity among overweight and
obese patients and those persons with type 2
diabetes mellitus(2,3).
It is estimated that around a quarter of the
world's adult population have metabolic syndrome
and they are twice as likely to die from and
three times as likely to have a heart attack
or stroke compared with people without the syndrome(4). In addition, the clustering of CVD risk
factors that typifies the metabolic syndrome
is now considered to be the driving force for
a CVD epidemic(5,6).
The major characteristics of metabolic syndrome
as initially defined by an expert panel of the
World Health Organization (WHO) in 1998(7)
includes insulin resistance, abdominal obesity,
elevated blood pressure, and lipid abnormalities
(i.e., elevated levels of triglycerides and
low levels of high-density lipoprotein [HDL]
cholesterol). The National Cholesterol Educational
Program The NCEP-ATP III(8,9) has created an
operational definition of metabolic syndrome
which is, the co-occurrence of any three of
the abnormalities mentioned above, apart from
not making waist circumference the central and
essential component; the recent ATP III criteria
are in line with those of International Diabetes
Federation (IDF)(7,8,10). Since there is no
internationally agreed upon definition for the
metabolic syndrome, the World Health Organization
(WHO)(11) has recently proposed a working definition
based on the signs of insulin resistance: Impaired
fasting blood glucose, Impaired glucose tolerance
(blood glucose above 140 mg/dl two hours after
a 75g glucose challenge). A diagnosis of Type
2 diabetes is automatically included, plus two
of the following: Blood pressure (=140 mm Hg
systolic or =90 mm Hg diastolic) or taking blood
pressure medication.
Plasma triglycerides =150 mg/dL, HDL cholesterol
<35 mg/dL in men or <39 mg/dL in women.
BMI = 30 kg/m2 and/or waist: hip ratio >0.9
in men, >0.85 in women. Urinary albumin excretion
rate =20 µg/min or albumin: creatinine
ratio =30 mg/g.
Objectives of Study
The study aims to determine the prevalence of
metabolic syndrome among patients with type
2 diabetes, and its relation to gender using
WHO criteria.
This study is a retrospective
study in which we reviewed the records of patients
with type 2 diabetes who attended a private
diabetic clinic in Aden during the period 2006-2007.
The data obtained from the records includes
data of body mass index (BMI), lipid profile
and blood pressure records which fulfill WHO
criteria for the diagnosis of MS. The patients'
records did not include waist circumference,
therefore WHO criteria applied were, type 2
diabetes, hypertension (blood pressure =140/90
mm Hg) with or without medication, dyslipidemia
(serum triglycerides 150 mg/dl or HDL cholesterol
<35mg/dl) and obesity (BMI = 30kg/ m2). A
total of 460 patients (260 males and 200 females)
with type-2 diabetes mellitus were screened.
Their mean age was 57 years. Age range was 39-75
years. Since all of our patients were type 2
diabetic, the presence of 2 metabolic abnormalities
other than DM, is needed to establish the diagnosis
of MS. Type 1 diabetic and pregnant patients
were not included in the study.
Out of these 460 diabetic patients, 201 (44%)
were found to have metabolic syndrome. Among
these 201 patients, 119 (59%) were males and
82 (41%) were females, indicating that the disease
is more dominant in males, as illustrated in
Table 1.
|
Table 1: Distribution
of metabolic syndrome by sex. |
|
Metabolic syndrome |
Sex |
Total |
|
M |
* % |
F |
* % |
No |
* % |
|
Yes |
119 |
59 |
82 |
41 |
201 |
44 |
|
No |
141 |
54 |
118 |
46 |
259 |
56 |
|
Total |
260 |
57 |
200 |
43 |
460 |
100 |
P value 0.3
* Percent calculated from total column. |
Table 2 shows the prevalence of different
components of metabolic syndrome according to
gender. Dyslipidemia is a common factor; it
was found in 69%, while hypertension and obesity
were found in 50.9 and 25.4 respectively.
|
Table 2: Distribution
of different components of metabolic syndrome
in type-2 diabetic patients according to
gender. |
|
Diabetics |
Sex |
Total |
P value |
|
Male |
%* |
F |
%** |
No |
%* |
|
Hypertension |
132 |
50.7 |
102 |
51 |
234 |
50.9 |
0.96 |
|
Dyslipidemia |
144 |
55 |
172 |
86 |
316 |
69 |
0.0000 |
|
Obesity |
63 |
24.2 |
54 |
27 |
117 |
25.4 |
0.56 |
* percent from
total male (260).
** percent from total female (200). |
Metabolic syndrome (MS)
has received a lot of attention recently because
of its importance as a health problem and because
of different definitions created by several
organizations such as, WHO, IDF, and NCEP ATP111.
Patients with Type 2 diabetes, which accounts
for 90 % of all diabetes, has become one of
the major causes of premature illness and death,
mainly through the increased risk of cardiovascular
disease (CVD)(3,12,13,14,15) and MS further
aggravates the situation. In this study the
prevalence of metabolic syndrome was 30.2 %
of study patients, and since the prevalence
of the MS and its components is mainly dependent
on the definition of metabolic syndrome(6,1,17), which is still not accepted for all
internationally, a single worldwide definition
will enable easier comparison of data from different
studies, therefore the results of many studies
have been controversial. In Saudi patients MS
is seen in 56% of patients with Type 2 diabetes,
and the commonest component of the syndrome
was hypertension as reported by Akbar(18).
Mansour(19) reported the highest prevalence
of MS which was 86% (82.7% of males and 94.5%
of females) among type 2diabetic patients in
Basrah. Huda AL-Ghareeb(20) reported the overall
prevalence of metabolic syndrome in her study
from Kuwait, was (39.19%). The females were
(37.7%) and males (41.1%). In this study the
rate is within the range of several studies
mentioned above(18,19,20), and hypertension
is again the commonest component of metabolic
syndrome. The explanation of this increased
rate of MS in this study could be due to physical
inactivity, sedentary behavior, and unhealthy
dietary habits.
-The rate of metabolic
syndrome in this study provides a useful tool
to identify high risk patients and to institute
proper treatment.
-The rate of metabolic syndrome in this study
predict an increased burden of cardiovascular
disease among Yemeni diabetic over the next
few years and call for effective healthcare
planning to contain this epidemic syndrome.
-This study is an effort to provide a baseline
data for future study using different definitions
of metabolic syndrome.
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