Epidemiology of the insulin resistance syndrome

Abstract

The insulin resistance syndrome consists of the co-occurrence of metabolic risk factors for type 2 diabetes and cardiovascular disease, including overall obesity, central obesity, dyslipidemia (characterized by elevated levels of triglycerides and low levels of high-density lipoprotein cholesterol), hyperglycemia, and hypertension. Using criteria proposed by the National Cholesterol Education Program Adult Treatment Panel III, national survey data suggest the insulin resistance syndrome is very common, affecting about 24% of US adults aged greater than 20 years. The syndrome is more common in older people and in Mexican Americans, and will increase in prevalence as populations age and become more obese. Identification of the syndrome warrants aggressive interventions known to prevent type 2 diabetes and cardiovascular disease, including weight reduction, increased physical activity, and control of hypertension and dyslipidemia.

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References and Recommended Reading

  1. 1.

    Boyle JP, Honeycutt AA, Narayan KM, et al.: Projection of diabetes burden through 2050: impact of changing demography and disease prevalence in the U.S. Diabetes Care 2001, 24:1936–1940.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Mokdad AH, Bowman BA, Ford ES, et al.: The continuing epidemics of obesity and diabetes in the United States. JAMA 2001, 286:1195–1200.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Kannel WB, McGee DL: Diabetes and cardiovascular disease: the Framingham Study. JAMA 1979, 241:2035–2038.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    UK Prospective Diabetes Study (UKPDS) 17. A 9-year update of a randomized, controlled trial on the effect of improved metabolic control on complications in non-insulin-dependent diabetes mellitus. UK Prospective Diabetes Study Group [no authors listed]. Ann Intern Med 1996, 124(1 pt 2):136–145.

  5. 5.

    Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37). U.K. Prospective Diabetes Study Group [no authors listed]. Diabetes Care 1999, 22:1125–1136.

    Article  Google Scholar 

  6. 6.

    Harris MI: Ambulatory medical care for diabetes. In Diabetes in America: Diabetes Data Compiled 1984. Publication 85-1468. Group NDD. Bethesda, MD: National Institutes of Health; 1985:XXV.1–13.

    Google Scholar 

  7. 7.

    Economic consequences of diabetes mellitus in the U.S. in 1997. American Diabetes Association [no authors listed]. Diabetes Care 1998, 21:296–309.

  8. 8.

    Reaven GM: Role of insulin resistance in human disease. Diabetes 1988, 37:1595–1607.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Meigs JB: Invited commentary: insulin resistance syndrome? Syndrome X? Multiple metabolic syndrome? A syndrome at all? Factor analysis reveals patterns in the fabric of correlated metabolic risk factors. Am J Epidemiol 2000, 152:908–911.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Haffner SM, Stern MP, Hazuda HP, et al.: Cardiovascular risk factors in confirmed prediabetic individuals: does the clock for coronary heart disease start ticking before the onset of diabetes? JAMA 1990, 263:2893–2898.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Stern MP, Haffner SM: Body fat distribution and hyperin-sulinemia as risk factors for diabetes and cardiovascular disease. Arteriosclerosis 1986, 6:123–130.

    PubMed  CAS  Google Scholar 

  12. 12.

    Haffner SM, Mykkanen L, Festa A, et al.: Insulin-resistant pre-diabetic subjects have more atherogenic risk factors than insulin sensitive prediabetic subjects: implications for preventing coronary heart disease during the prediabetic state. Circulation 2000, 101:975–980. This is one of many important papers from the San Antonio Heart Study investigators documenting the role of insulin resistance as a precursor to type 2 diabetes and CVD. The paper also provides data accounting for the high rates of CVD in nondiabetic subjects who subsequently develop type 2 diabetes.

    PubMed  CAS  Google Scholar 

  13. 13.

    Salonen JT, Lakka TA, Laaka H-M, et al.: Hyperinsulinemia is associated with the incidence of hypertension and dyslipidemia in middle-aged men. Diabetes 1998, 47:270–275.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Yarnell JW, Patterson CC, Bainton D, Sweetnam PM: Is metabolic syndrome a discrete entity in the general population? Evidence from the Caerphilly and Speedwell population studies. Heart 1998, 79:248–252.

    PubMed  CAS  Google Scholar 

  15. 15.

    Wilson PWF, Kannel WB, Silbershatz H, D’Agostino RB: Clustering of metabolic factors and coronary heart disease. Arch Intern Med 1999, 159:1104–1109.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Schmidt MI, Watson RL, Duncan BB, et al.: Clustering of dyslipidemia, hyperuricemia, diabetes, and hypertension and its association with fasting insulin and central and overall obesity in a general population. Metabolism 1996, 45:699–706.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Bonora E, Kiechl S, Willeit J, et al.: Prevalence of insulin resistance in metabolic disorders. Diabetes 1998, 47:1643–1649.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Meigs JB, D’Agostino RB, Wilson PWF, et al.: Risk variable clustering in the insulin resistance syndrome: the Framingham Offspring Study. Diabetes 1997, 46:1594–1600.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Lillioja S, Mott DM, Spraul M, et al.: Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus. N Engl J Med 1993, 329:1988–1992.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Despres J-P, Lamarche B, Mauriege P, et al.: Hyperinsulinemia as an independent risk factor for ischemic heart disease. N Engl J Med 1996, 334:952–957.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Kekalainen P, Sarlund H, Pyorala K, Laakso M: Hyperinsulinemia cluster predicts the development of type 2 diabetes independent of a family history of diabetes. Diabetes Care 1999, 22:86–92.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Lempiainen P, Mykkanen L, Pyorala K, et al.: Insulin resistance syndrome predicts coronary heart disease events in elderly nondiabetic men. Circulation 1999, 100:123–128.

    PubMed  CAS  Google Scholar 

  23. 23.

    Pyorala M, Miettinen H, Halonen P, et al.: Insulin resistance syndrome predicts the risk of coronary heart disease and stroke in healthy middle-aged men: the 22-year follow-up results of the Helsinki Policemen Study. Arterioscler Thromb Vasc Biol 2000, 20:538–544.

    PubMed  CAS  Google Scholar 

  24. 24.

    Isomaa B, Almgren P, Tuomi T, et al.: Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001, 24:683–689. Data from a family diabetes study in Finland and Sweden provide evidence that the insulin resistance syndrome increases risk for CVD. Also provides data on the prevalence of the insulin resistance syndrome by the WHO criteria, but the source is a high-risk cohort so rates overestimate the prevalence that would be expected in an unselected, population-based sample.

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Wilson PWF, D’Agostino RB, Parise H, Meigs JB: The metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus [abstract]. Diabetes 2002, 51(suppl 1):980-P.

    Google Scholar 

  26. 26.

    Balkau B, Charles MA: Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med 1999, 16:442–443.

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Alberti KG, Zimmet PZ: Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998, 15:539–553.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III) [no authors listed]. JAMA 2001, 285:2486–2497. Provides the NCEP ATP III criteria for the "metabolic syndrome." Also provides the evidence base for the importance of lipid lowering to prevent CVD events.

  29. 29.

    Knowler WC, Barrett-Connor E, Fowler SE, et al.: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002, 346:393–403. The DPP firmly establishes that weight loss and increased physical activity prevent the development of type 2 diabetes. These findings are likely to extend to insulin resistance-related disorders in general. The interventions are feasible to deliver in clinical practice. This is required reading for all clinicians and public health personnel.

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Tuomilehto J, Lindstrom J, Eriksson JG, et al.: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001, 344:1343–1350.

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Pan XR, Li GW, Hu YH, et al.: Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997, 20:537–544.

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Joint National Committee on Prevention D, Evaluation, and Treatment of High Blood Pressure [no authors listed]. Arch Intern Med 1997, 157:2413–2446.

  33. 33.

    Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998, 352:854–865.

  34. 34.

    Ghazzi MN, Perez JE, Antonucci TK, et al.: Cardiac and glycemic benefits of troglitazone treatment in NIDDM. Diabetes 1997, 46:433–439.

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Minamikawa J, Tanaka S, Yamauchi M, et al.: Potent inhibitory effect of troglitazone on carotid arterial wall thickness in type 2 diabetes. J Clin Endocrinol Metab 1998, 83:1818–1820.

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Azen SP, Peters RK, Berkowitz K, et al.: TRIPOD (Troglitazone In the Prevention Of Diabetes): a randomized, placebo-controlled trial of troglitazone in women with prior gestational diabetes mellitus. Control Clin Trials 1998, 19:217–231.

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Freeman DJ, Norrie J, Sattar N, et al.: Pravastatin and the development of diabetes mellitus: evidence for a protective treatment effect in the West of Scotland Coronary Prevention Study. Circulation 2001, 103:357–362.

    PubMed  CAS  Google Scholar 

  38. 38.

    Yusuf S, Gerstein H, Hoogwerf B, et al.: Ramipril and the development of diabetes. JAMA 2001, 286:1882–1885.

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    de Vegt F, Dekker JM, Stehouwer CD, et al.: The 1997 American Diabetes Association criteria versus the 1985 World Health Organization criteria for the diagnosis of abnormal glucose tolerance: poor agreement in the Hoorn Study. Diabetes Care 1998, 21:1686–1690.

    PubMed  Article  Google Scholar 

  40. 40.

    Stern MP, Williams K, Haffner SM: Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test? Ann Intern Med 2002, 136:575–581.

    PubMed  Google Scholar 

  41. 41.

    Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002, 287:356–359. Ford et al. provide the first description of the prevalence of the insulin resistance syndrome in the United States, based on the valuable NHANES III survey. This analysis includes subjects with diabetes and thus somewhat overestimates the prevalence of the syndrome in the United States during the early 1990s.

    PubMed  Article  Google Scholar 

  42. 42.

    Mokdad AH, Serdula MK, Dietz WH, et al.: The spread of the obesity epidemic in the United States, 1991–1998. JAMA 1999, 282:1519–1522.

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Hu FB, Manson JE, Stampfer MJ, et al.: Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 2001, 345:790–797.

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Liese AD, Mayer-Davis EJ, Tyroler HA, et al.: Familial components of the multiple metabolic syndrome: the ARIC study. Diabetologia 1997, 40:963–970.

    PubMed  Article  CAS  Google Scholar 

  45. 45.

    Carmelli D, Cardon LR, Fabsitz R: Clustering of hypertension, diabetes, and obesity in adult male twins: same genes or same environments? Am J Hum Genet 1994, 55:566–573.

    PubMed  CAS  Google Scholar 

  46. 46.

    Edwards KL, Newman B, Mayer E, et al.: Heritability of factors of the insulin resistance syndrome in women twins. Genet Epidemiol 1997, 14:241–253.

    PubMed  Article  CAS  Google Scholar 

  47. 47.

    Mitchell BD, Kammerer CM, Mahaney MC, et al.: Genetic analysis of the IRS. Pleiotropic effects of genes influencing insulin levels on lipoprotein and obesity measures. Arterioscler Thromb Vasc Biol 1996, 16:281–288.

    PubMed  CAS  Google Scholar 

  48. 48.

    Kissebah AH, Sonnenberg GE, Myklebust J, et al.: Quantitative trait loci on chromosomes 3 and 17 influence phenotypes of the metabolic syndrome. Proc Natl Acad Sci U S A 2000, 97:14478–14483.

    PubMed  Article  CAS  Google Scholar 

  49. 49.

    Arya R, Blangero J, Williams K, et al.: Factors of insulin resistance syndrome-related phenotypes are linked to genetic locations on chromosomes 6 and 7 in nondiabetic Mexican-Americans. Diabetes 2002, 51:841–847.

    PubMed  Article  CAS  Google Scholar 

  50. 50.

    Pinkney JH, Stehouwer CD, Coppack SW, Yudkin JS: Endothelial dysfunction: cause of the insulin resistance syndrome. Diabetes 1997, 46(suppl 2):S9-S13.

    PubMed  CAS  Google Scholar 

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Meigs, J.B. Epidemiology of the insulin resistance syndrome. Curr Diab Rep 3, 73–79 (2003). https://doi.org/10.1007/s11892-003-0057-2

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Keywords

  • Metformin
  • Troglitazone
  • Metabolic Risk Factor
  • Diabetes Prevention Program
  • Insulin Resistance Syndrome