title: Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance.
abstract: OBJECTIVE
  To determine the association of metabolic syndrome (MetS) and its components with diabetes risk in participants with impaired glucose tolerance (IGT), and whether intervention-related changes in MetS lead to differences in diabetes incidence.
  
  
  METHODS
  We used the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) revised MetS definition at baseline and intervention-related changes of its components to predict incident diabetes using Cox models in 3234 Diabetes Prevention Program (DPP) participants with IGT over an average follow-up of 3.2 years.
  
  
  RESULTS
  In an intention-to-treat analysis, the demographic-adjusted hazard ratios (95% confidence interval) for diabetes in those with MetS (vs. no MetS) at baseline were 1.7 (1.3-2.3), 1.7 (1.2-2.3) and 2.0 (1.3-3.0) for placebo, metformin and lifestyle groups, respectively. Higher levels of fasting plasma glucose and triglycerides at baseline were independently associated with increased risk of diabetes. Greater waist circumference (WC) was associated with higher risk in placebo and lifestyle groups, but not in the metformin group. In a multivariate model, favourable changes in WC (placebo and lifestyle) and high-density lipoprotein cholesterol (placebo and metformin) contributed to reduced diabetes risk.
  
  
  CONCLUSIONS
  MetS and some of its components are associated with increased diabetes incidence in persons with IGT in a manner that differed according to DPP intervention. After hyperglycaemia, the most predictive factors for diabetes were baseline hypertriglyceridaemia and both baseline and lifestyle-associated changes in WC. Targeting these cardiometabolic risk factors may help to assess the benefits of interventions that reduce diabetes incidence.
authors.affiliation: Geriatric Research, Education, and Clinical Center, Miami Veterans Affairs Healthcare System and Divisions of Epidemiology, Geriatric Medicine & Endocrinology, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: H
authors.initials: H
authors.lastname: Florez
authors.forename: M G
authors.initials: MG
authors.lastname: Temprosa
authors.forename: T J
authors.initials: TJ
authors.lastname: Orchard
authors.forename: K J
authors.initials: KJ
authors.lastname: Mather
authors.forename: S M
authors.initials: SM
authors.lastname: Marcovina
authors.forename: E
authors.initials: E
authors.lastname: Barrett-Connor
authors.forename: E
authors.initials: E
authors.lastname: Horton
authors.forename: C
authors.initials: C
authors.lastname: Saudek
authors.forename: X F
authors.initials: XF
authors.lastname: Pi-Sunyer
authors.forename: R E
authors.initials: RE
authors.lastname: Ratner
authors.forename: R B
authors.initials: RB
authors.lastname: Goldberg
mesh_terms: D000367:Age Factors; D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D004038:Diet, Reducing; D015444:Exercise; D005215:Fasting; D005260:Female; D018149:Glucose Intolerance / Q000150:complications* / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012074:Remission Induction; D012307:Risk Factors; D040242:Risk Reduction Behavior; D014280:Triglycerides / Q000097:blood*; D055105:Waist Circumference
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D014280:Triglycerides; D008687:Metformin
keywords: cardiometabolic risk; diabetes prevention; lifestyle; metformin