The “metabolic syndrome” is less useful than random plasma glucose to screen for glucose intolerance

Received 10 January 2008; received in revised form 6 March 2008; accepted 27 April 2008. published online 13 June 2008.

Abstract

Aims

To compare the utility of metabolic syndrome (MetS) to random plasma glucose (RPG) in identifying people with diabetes or prediabetes.

Methods

RPG was measured and an OGTT was performed in 1155 adults. Test performance was measured by area under the receiver-operating-characteristic curve (AROC).

Results

Diabetes was found in 5.1% and prediabetes in 20.0%. AROC for MetS with fasting plasma glucose (FPG) was 0.80 to detect diabetes, and 0.76 for diabetes or prediabetes—similar to RPG alone (0.82 and 0.72). However, the AROC for MetS excluding fasting plasma glucose was lower: 0.69 for diabetes (p<0.01 vs. both RPG and MetS with FPG), and 0.69 for diabetes or prediabetes. AROCs for MetS with FPG and RPG were comparable and higher for recognizing diabetes in blacks vs. whites, and females vs. males. MetS with FPG was superior to RPG for identifying diabetes only in subjects with age <40 or BMI <25.

Conclusions

MetS features can be used to identify risk of diabetes, but predictive usefulness is driven largely by FPG. Overall, to identify diabetes or prediabetes in blacks and whites with varying age and BMI, MetS is no better than RPG—a more convenient and less expensive test.

Abbreviations: AGI110, any glucose intolerance110 (diabetes or IGT or IFG110–125), ARIC, Atherosclerosis Risk in Communities study, AROC, area under the ROC curve, DETECT-2, “international data pooling collaboration specifically addressing issues related to screening for type 2 diabetes”, dysglycemia, type 2 diabetes or IGT or IFG110, EPIC-Norfolk, European Prospective Investigation of Cancer-Norfolk, FPG, fasting plasma glucose, GCRC, General Clinical Research Center, Health ABC, Health, Aging, and Body Composition study, HDL, high density lipoprotein, IFG, impaired fasting glucose, IFG110 or IFG110–125, IFG with fasting plasma glucose 110–125

mg/dl, IGT, impaired glucose tolerance, NCEP, National Cholesterol Education Program, NHANES-III, National Health and Nutrition Examination Survey III, Prediabetes, IGT and/or IFG110, ROC, receiver-operating-characteristic, RPG, random (nonfasting) plasma glucose, T2DM, type 2 diabetes mellitus, WHO, World Health Organization

Keywords: Screening, Type 2 diabetes, Prediabetes, Impaired glucose intolerance, Impaired fasting glucose

a Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States

b Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States

c Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States

d Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, United States

e Veterans Administration Medical Center, Atlanta, GA, United States

Corresponding author at: Division of Endocrinology and Metabolism, Emory University School of Medicine, 101 Woodruff Circle, WMRB Room 1027, Atlanta, GA 30322, United States. Tel.: +1 404 717 1392; fax: +1 404 727 1300.

1 On sabbatical leave from El Minia University School of Medicine, Egypt.

2 Current address: Christiana Hospital, Newark, DE, United States.

PII: S1751-9918(08)00039-9

doi:10.1016/j.pcd.2008.04.005

Published by Elsevier Inc.

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