Diagnostic Criteria For Diabetes Prediabetes And Metabolic Syndrome

Table 2-2. Definitions of the Metabolic Syndrome

WHO (1999)

NCEP ATP Iii (2001)

IDF (2004)

IGT or diabetes and/or

Three or more of the following

Central obesity (ethnicity-specific) PLUS any

insulin resistance* PLUS

five risk factors:

two of the following five factors:

two or more of the

following factors:

Fasting plasma

>100 mg/dL (5.6 mmol/L)'

>100 mg/dL (5.6 mmol/L) or previously diagnosed

glucose

diabetes

Blood pressure

>140/90 mm Hg

>130/>85 mm Hg

>130 or >85 mm Hg or treatment of previously diagnosed hypertension

Triglycerides

>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

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)

Women: <39 mg/dL (1.0 mmol/L)

Women: <50 mg/dL (1.29 mmol/L)

Women: <50 mg/dL (1.29 mmol/L)

Obesity

Men: waist-hip ratio >0.90

Men: waist circumference

Europid* men: waist circumference >94 cm

Women: waist-hip ratio

>1 02 cm

>0.85 and/or BMI >30 kg/m2

Women: waist circumference

Europid* women: waist circumference >80 cm

>88 cm

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.)

Metabolic Syndrome Criteria 2018

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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