Metabolic syndrome in subjects at high risk for type 2 diabetes: The genetic, physiopathology and evolution of type 2 diabetes (GENFIEV) study

Bianchi, C.; Miccoli, R.; Bonadonna, R.C.; Giorgino, F.; Frontoni, S.; Faloia, E.; Marchesini, G.; Dolci, M.A.; Alviggi, L.; Gnasso, A.; Consoli, A.; Cavalot, F.; Cavallo, M.G.; Leonetti, F.; Giaccari, A.; Del Prato, S.; On Behalf of the GENFIEV Investigators,

doi:10.1016/j.numecd.2010.03.006

« Previous Next »Nutrition, Metabolism & Cardiovascular Diseases
Volume 21, Issue 9 , Pages 699-705, September 2011

Metabolic syndrome in subjects at high risk for type 2 diabetes: The genetic, physiopathology and evolution of type 2 diabetes (GENFIEV) study

C. Bianchi
- Department of Endocrinology and Metabolism, Section of Diabetes and Metabolic Diseases, University of Pisa, Pisa, Italy
R. Miccoli
- Department of Endocrinology and Metabolism, Section of Diabetes and Metabolic Diseases, University of Pisa, Pisa, Italy
R.C. Bonadonna
- Department of Biomedical and Surgical Sciences, Section of Endocrinology and Metabolic Diseases, University of Verona, Verona, Italy
F. Giorgino
- Department of Emergency and Organ Transplantation, Section on Internal Medicine, Endocrinology and Metabolic, Diseases, University of Bari, Bari, Italy
S. Frontoni
- Diabetes Center, Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
E. Faloia
- Division of Endocrinology, Polytechnic University of Marche, Ancona, Italy
G. Marchesini
- Clinical Dietetics, Alma Mater Studiorum University of Bologna, Bologna, Italy
M.A. Dolci
- Section of Diabetes and Metabolic Diseases, SS. Giacomo e Cristoforo Hospital, Massa, Italy
L. Alviggi
- Section of Diabetes and Metabolic Diseases, Hospital of Pistoia, Pistoia, Italy
A. Gnasso
- Department of Clinical and Experimental Medicine, University of Catanzaro, Catanzaro, Italy
A. Consoli
- Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy
F. Cavalot
- Diabetes Unit, Department of Clinical Biological Sciences, University of Turin, Turin, Italy
M.G. Cavallo
- Department of Clinic and Medical Therapy, Univeristy of Roma “La Sapienza”, Rome, Italy
F. Leonetti
- Department of Clinical Sciences, University of Roma “La Sapienza”, Rome, Italy
A. Giaccari
- Endocrinology, Catholic University of Roma and Don Gnocchi Foundation, Milan, Italy
S. Del Prato
- Department of Endocrinology and Metabolism, Section of Diabetes and Metabolic Diseases, University of Pisa, Pisa, Italy
- Corresponding author. Tel.: +39 050 995103; fax: +39 050 541521.
On Behalf of the GENFIEV Investigators
- The GENFIEV investigators – Bari: A. Cignarelli; Bologna: F. Cerrelli, S. Moscatiello; Catanzaro: C. Irace; Chieti: M. Taraborelli, G. Formoso; Massa: M. Mori, F. Baccetti; Torino: A.M. Trovati, K. Bonomo; Pisa: G. Penno, A. Agostini; Pistoia: A. De Bellis; R. Anichini; Roma Tor Vergata: D. Bracaglia; D. Perna; Roma “La Sapienza”: M. Calabria, A. Zappaterreno, I. Barchetta, G. Taverni; Roma Cattolica: A. Antonelli; Verona: M. Trombetta, A. Calì.

Received 22 August 2009; received in revised form 17 March 2010; accepted 24 March 2010. published online 09 November 2010.

Abstract

Background and Aim

We evaluated the relationship between insulin resistance (IR) and insulin secretion with the metabolic syndrome (MS) in 885 subjects (377 men/508 women, age 49±11 years, BMI 29±5.2kgm⁻²) at risk of diabetes enrolled in the genetics, pathophysiology and evolution of type 2 diabetes (GENFIEV) study.

Methods and Results

All subjects underwent a 75-g oral glucose tolerance test (OGTT) for the estimation of plasma levels of glucose and C-peptide, as well as fasting insulin and lipid profile. IR was arbitrarily defined as HOMA-IR value above the 75th centile of normal glucose tolerance (NGT) subjects. Overall MS prevalence (National Cholesterol Treatment Panel–Adult Treatment Panel (NCEP–ATPIII) criteria) was 33%, 19% in subjects with NGT, 42% in impaired fasting glucose (IFG), 34% in impaired glucose tolerance (IGT), 74% in IFG+IGT subjects, and 56% in newly diagnosed diabetic patients. Prevalence was slightly higher with IDF criteria. MS prevalence was >50% in subjects with 2h glucose >7.8mmoll⁻¹, independently of fasting plasma glucose. IR prevalence was higher in subjects with MS than in those without (63% vs. 23%; p<0.0001) and increased from 54% to 73% and 88% in the presence of three, four or five traits, respectively. IR occurred in 42% of subjects with non-diabetic alterations of glucose homeostasis, being the highest in those with IFG+IGT (IFG+IGT 53%, IFG 45%, IGT 38%; p<0.0001). Individuals with MS were more IR irrespective of glucose tolerance (p<0.0001) with no difference in insulinogenic index. Hypertriglyceridaemia (OR: 3.38; Confidence Interval, CI: 2.294.99), abdominal obesity (3.26; CI: 2.18–4.89), hyperglycaemia (3.02; CI: 1.80–5.07) and hypertension (1.69; CI: 1.12–2.55) were all associated with IR.

Conclusions

These results show that in subjects with altered glucose tolerance (in particular IFG+IGT) MS prevalence is high and is generally associated to IR. Some combinations of traits of MS may significantly contribute to identify subjects with IR.

Keywords: Metabolic syndrome, Insulin resistance, Impaired glucose regulation