Abstract
Aim: The study aimed to investigate the prevalence of metabolic syndrome (MetS) and its determinants in newly-diagnosed adult-onset diabetes in China.Methods: From April 2015 to October 2017, 15,492 consecutive patients with diabetes diagnosed within 1 year and aged ≥30 years were recruited from 46 tertiary care hospitals in 24 cities across China. Glutamic acid decarboxylase autoantibody was assayed centrally and clinical data were collected locally. Classic type 1 diabetes mellitus (T1DM), latent autoimmune diabetes in adults (LADA) and type 2 diabetes mellitus (T2DM) were defined using the criteria of American Diabetes Association, Immunology of Diabetes Society and World Health Organization. MetS was defined using Chinese Diabetes Society's criteria. Logistic regression analysis was used to obtain odds ratios (OR) of determinants of MetS.Results: The overall prevalence of MetS was 66.5%, with the highest prevalence in T2DM (68.1%), followed by those in LADA (44.3%) and T1DM (34.2%) (P < 0.05 for all comparisons). After adjustment for traditional risk factors, T2DM had a 2.8-fold [95% confidence interval (CI): 2.36–3.37] MetS risk compared with LADA, whereas T1DM had significantly lower OR than LADA (OR: 0.68, 95% CI: 0.50–0.92). After further adjustment for insulin resistance, the OR of T2DM vs. LADA was slightly reduced but the OR of T1DM vs. LADA was greatly attenuated to non-significance (OR: 0.96, 95% CI: 0.70–1.33). In addition to types of diabetes, age, gender, geographical residence, education attainment, alcohol consumption and HOMA2-IR were independent determinants of MetS.Conclusions: MetS was highly prevalent, not only in T2DM but also in T1DM and LADA in Chinese newly diagnosed patients; higher risk of MetS in LADA than in T1DM was partially attributable to higher insulin resistance in LADA.
Highlights
Metabolic syndrome (MetS) is a constellation of cardiometabolic risk factors, the core components of which involve insulin resistance, abdominal obesity, hypertension, hyperglycemia, and dyslipidemia
Using latent autoimmune diabetes in adults (LADA) as the referent group, patients with type 2 diabetes mellitus (T2DM) had higher odds of MetS (OR: 2.69, 95% confidence intervals (CIs): 2.27–3.17), while patients with type 1 diabetes mellitus (T1DM) had lower odds of MetS (OR: 0.65, 95% CI: 0.49–0.87) (Model 1, Table 2)
The decreased risk of MetS in T1DM (OR: 0.68, 95% CI: 0.50–0.92) and increased risk of MetS in T2DM (OR: 2.82, 95% CI: 2.36–3.37) persisted after adjustment for age, gender, region, education attainment, family history of diabetes, smoking and alcohol consumption habits (Model 2, Table 2)
Summary
Metabolic syndrome (MetS) is a constellation of cardiometabolic risk factors, the core components of which involve insulin resistance, abdominal obesity, hypertension, hyperglycemia, and dyslipidemia. MetS increases the risks of cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM) and all-cause mortality [1]. Identifying patients with MetS is critical for precise intervention targeting insulin resistance and CVD protection. It is well-known that MetS is prevalent in type 2 diabetes, but the exact status of MetS in different types of diabetes and its determinants remain undefined. The two subtypes of autoimmune diabetes, classic type 1 diabetes mellitus (T1DM) and latent autoimmune diabetes in adults (LADA), are of great clinical heterogeneity and different treatment regimes. LADA lies in between T1DM and T2DM regarding autoimmune, inflammatory, metabolic and genetic features, often described as “end of the rainbow” [6]. T1DM, LADA and T2DM jointly constitute a continuum of varying degrees of clinical features and β-cell function
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