Diagnostic Criteria For Diabetes Prediabetes And Metabolic Syndrome
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Table 2-2. Definitions of the Metabolic Syndrome | |||
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WHO (1999) |
NCEP ATP Iii (2001) |
IDF (2004) | |
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IGT or diabetes and/or |
Three or more of the following |
Central obesity (ethnicity-specific) PLUS any | |
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insulin resistance* PLUS |
five risk factors: |
two of the following five factors: | |
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two or more of the | |||
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following factors: | |||
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Fasting plasma |
— |
>100 mg/dL (5.6 mmol/L)' |
>100 mg/dL (5.6 mmol/L) or previously diagnosed |
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glucose |
diabetes | ||
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Blood pressure |
>140/90 mm Hg |
>130/>85 mm Hg |
>130 or >85 mm Hg or treatment of previously diagnosed hypertension |
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>150 mg/dL (1.7 mmol/L) and/or |
>150 mg/dL (1.7 mmol/L) |
>150 mg/dL (1.7 mmol/L) or specific treatment for this abnormality | |
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HDL-cholesterol |
Men: <35 mg/dL (0.9 mmol/L) |
Men: <40 mg/dL (1.03 mmol/L) |
Men: <40 mg/dL (1.03 mmol/L) |
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Women: <39 mg/dL (1.0 mmol/L) |
Women: <50 mg/dL (1.29 mmol/L) |
Women: <50 mg/dL (1.29 mmol/L) | |
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Obesity |
Men: waist-hip ratio >0.90 |
Men: waist circumference |
Europid* men: waist circumference >94 cm |
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Women: waist-hip ratio |
>1 02 cm | ||
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>0.85 and/or BMI >30 kg/m2 |
Women: waist circumference |
Europid* women: waist circumference >80 cm | |
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>88 cm | |||
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Microalbuminuria |
>20 |g/min or albumin-creatinine ratio >30 mg/g |
— | |
BMI, body mass index; HDL, high-density lipoprotein; IDF, International Diabetes Federation; IGT, impaired glucose tolerance; NCEP ATP III, Adult Treatment Panel III of the National Cholesterol Education Program; WHO, World Health Organization.
"Insulin resistance: insulin sensitivity measured under hyperinsulinemic euglycemic conditions, glucose uptake below lowest quartile for background population under investigation.
'The 2001 American Diabetes Association (ADA) definition identified fasting plasma glucose of >110 mg/dL (6.1 mmol/L) as elevated. This was modified in 2004 to be >100 mg/dL (5.6 mmol/L), in accordance with the ADA's updated definition of impaired fasting glucose.
'The values for other ethnic groups are reported in the manuscript.
Adapted from Alberti KG, Zimmet P, Shaw J: Metabolic syndrome: A new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med 2006;23:469-480.
BMI, body mass index; HDL, high-density lipoprotein; IDF, International Diabetes Federation; IGT, impaired glucose tolerance; NCEP ATP III, Adult Treatment Panel III of the National Cholesterol Education Program; WHO, World Health Organization.
"Insulin resistance: insulin sensitivity measured under hyperinsulinemic euglycemic conditions, glucose uptake below lowest quartile for background population under investigation.
'The 2001 American Diabetes Association (ADA) definition identified fasting plasma glucose of >110 mg/dL (6.1 mmol/L) as elevated. This was modified in 2004 to be >100 mg/dL (5.6 mmol/L), in accordance with the ADA's updated definition of impaired fasting glucose.
'The values for other ethnic groups are reported in the manuscript.
Adapted from Alberti KG, Zimmet P, Shaw J: Metabolic syndrome: A new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med 2006;23:469-480.
Figure 2-2. Pathophysiology of diabetes mellitus-associated coronary artery disease. AGE, advanced glycation end products; AT, antithrombin; GP, glycoprotein; hsCRP, high-sensitivity C-reactive protein; ICAM-1, intracellular adhesion molecule-1; IL-6, interleukin-6; NO, nitric oxide; PAI-1, plasminogen activator inhibitor-1; PPAR-y, peroxisome proliferator-activated receptor-y; RAGE, receptor for AGE; sCD40L, soluble CD40 ligand; TF, tissue factor; TNF-a, tumor necrosis factor-a; TSP-1, thrombospondin-1; VCAM-1, vascular cell adhesion molecule-1; vWF, von Willebrand factor. (Adapted from Roffi M, Topol EJ: Percutaneous coronary intervention in diabetic patients with non-ST-segment elevation acute coronary syndromes. Eur Heart J 2004;25:190-198.)
resistance, have been associated with the accelerated atherogenesis observed in diabetes and may confer vulnerability for CV events, both spontaneous and in the setting of coronary revascularization (Fig. 2-2).9 In addition to metabolic disturbances, diabetes alters the function of multiple cell lines, including endothelial cells, smooth muscle cells, and platelets. Despite the description of several peculiarities charac terizing diabetes-associated atherosclerosis, the exact mechanisms underlying the initiation and progression of the atherosclerotic process remain elusive.
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