Metabolic Syndrome in Subjects with Type-2 Diabetes Mellitus: PATIENTS AND METHODS
A total of 218 subsamples of consecutive patients with type-2 diabetes seen between September 1999 and August 2001, in both the medical outpatient department and the medical wards of the Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria were studied.
Type-2 diabetic subjects were those who: 1) were treated with oral hypoglycemic agents only; 2) were treated with oral hypoglycemic agents only but required insulin medication during an acute illness; 3) whose diabetic state has been controlled on diet but previously on oral hypoglycemic agents; 4) have diabetes onset after the age of 40 years and a body mass index (BMI) above normal (>25 kg/m2 in females and >27 kg/m2 in males).
Clinical parameters, including age, sex, duration of diabetes mellitus, drug therapy, BMI, and presence of hypertension, were recorded. BMI was calculated as the ratio of weight (kilograms) to standing height (meters) squared (kg/m2); participants with a BMI 30 kg nr2 were classified as obese. To calculate waist-to-hip ratio (WHR), waist girth was measured at the umbilicus, and hip girth was measured as the largest diameter around the gluteal muscles. Blood pressure was measured by standard mercury sphygmomanometer after five minutes in supine position and recorded to the nearest 2 mmHg. Cuff size 20-31 cm was used in patients with an upper-arm circumference less than 32 cm, and cuff size 28-36 cm was used in patients with an upper-arm circumference above 32 cm. Systolic and diastolic blood pressures were taken as the appearance and disappearance of the Korotkoff sounds (phases I & V, respectively). Hypertension was defined as systolic blood pressure of > 140 mmHg and/or diastolic blood pressure of >90 mmHg. Patients already on antihypertensives were taken as hypertensive. Occurrence of ischemic heart disease and stroke were taken from clinical history and previous documents or as an acute event and mortality recorded. Peripheral vascular disease was defined as an ankle-to-brachial systolic pressure ratio of less than 0.9 in either leg. Appropriate cuff sizes were used to measure ankle blood pressure over the posterior tibial vessels. Stroke was defined as the sudden or rapid onset of focal or global neurologic symptoms lasting more than 24 hours or leading to death and of vascular cause. buy prescription drugs without prescription
Early-morning urine specimen was taken from all eligible subjects. Each urine sample was divided into two parts: protein was first tested for in one part using the AT strip and then using the SAT. AT strips were used according to the manufacturer’s instructions and results recorded as negative, trace, or 1 + positive. In the urine protein precipitation test with SAT, five drops of 20% sulfosalicylic acid were added to 3 mis of urine in one test tube, and that tube was compared with a tube of untreated urine held against a dark background. Tubes were to be observed immediately by two independent observers, and a result was assumed positive if both observers agreed after the addition of sulfosalicylic acid; turbidity was taken to indicate proteinuria. Combined negative results from these two tests (SAT and AT), were taken as excluding microalbuminuria.
Laboratory parameters, including plasma cholesterol and triglycerides, fasting, and two hours postprandial blood sugars, were estimated. Patients were diagnosed as having MS according to the WHO criteria: • Central obesity (males: WHR >0.90; females:
WHR >0.85) and/or BMI >30 kg m2;
• Dyslipidemia—raised plasma triglycerides (>1.7 mmol l-1;150mg dl1) and/or low HDL-choles-terol (<0.9 mmol l1, 35 mg dl1 men; < 1.0 mmol l1, 39 mg dl”1 women); • Hypertension defined as systolic blood pressure of > 140 mmHg and or diastolic blood pressure of >90 mmHg. Patients already on antihypertensives were taken as hypertensive;
• Microalbuminuria (urinary albumin excretion rate >20 jug min1 or albumin:creatinine ratio >30 mg g1)-
A subject with type-2 diabetes is taken as having MS if two of the criteria are fulfilled. Quantitative data was expressed as mean ± SD. Students’ t- and Chi-squared tests were used to assess the difference between the various subject groups. Statistical significance was placed at p<0.05.
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