Prevalence of Metabolic Syndrome in Pre and Post Menopausal Diabetics

This study was designed to determine the frequency of metabolic syndrome in diabetic females and to compare the pre-menopausal and post-menopausal diabetics for the presence of metabolic syndrome. This is a comparative cross-sectional study carried out at the Out patient diabetic clinic Mayo Hospital, Lahore, from Jan., 2007 to May 2007. All adult diabetic females coming for regular checkup to out patient department of diabetic clinic during our study duration were included and informed their consent was taken. The data was collected using a structured questionnaire. Metabolic syndrome was defined according to National Cholesterol Education Program Adult Treatment Panel III. There were 200 participants in the study, hundred were pre-menopausal and the remaining post-menopausal. Among them 30% cases were hypertensive, 28% cases were obese 10% had dyslipidaemia. Eight percent had increased triglyceride level and 2% had decreased high density lipoproteins level. Metabolic syndrome was found in 28% of diabetic females, 21% of post-menopausal and 7% of pre-menopausal diabetics. Thus the comparison for the presence of metabolic syndrome showed a significant value (p<0.05). All diabetics especially post-menopausal females should be assessed for the presence of metabolic syndrome for better quality of life and prevention of complications. INTRODUCTION According to World Health Organization, at least 171 million people worldwide suffer from diabetes. Its incidence is increasing rapidly, and it is estimated that by the year 2030, this number will double.1 Its association with metabolic syndrome results in a bleak picture by increasing the risk of ischaemic heart disease and stroke. Clinical features are fasting hyperglycaemia, high blood pressure, central obesity (also known as visceral, male-pattern or apple shaped adiposity), overweight with fat deposits mainly around the waist, decreased HDL, elevated triglycerides, elevated uric acid levels.1 Fortunately metabolic syndrome is preventable by life style modification, creating awareness, early diagnosis and treatment. The National Cholesterol Education Program Adult Treatment Panel III (2001) requires at least three of the following to diagnose metabolic syndrome.2 1. Obesity/waist circumference> 102 cm or 40 inches (males), >88 cm or 36 inches (females). 2. Dyslipidaemia: Triglycerides> 150 (mg/dl). 3. Dyslipidaemia: High density lipoproteins < 40 mg/dl (male), 50 mg/dl (female). 4. Blood pressure> 130/85 mm Hg. 5. Fasting plasma glucose>l 10 mg/dl. The pathophysiology of metabolic syndrome is complex and has only been partially elucidated. Most patients are older, obese, sedentary, and have a degree of insulin resistance. The most important risk factors in order are3: 1. Lifestyle i.e decreased physical activity and excess caloric intake. 2. Age. 3. Gender. 4. Genetics. Thus we planned a study to find the magnitude of problem of metabolic syndrome in our diabetic females coming for regular check-ups in out patient Diabetic Clinic of a teaching hospital and to compare the pre and post menopausal diabetics for the factors of metabolic syndrome. By doing so proper measures should be taken to prevent the deadly complications of metabolic syndrome in time and awareness can be created to achieve life style modifications in diabetics before they end up in metabolic syndrome and its associated mortality. PATIENTS AND METHODS It was a cross-sectional study, conducted at the out patient diabetic clinic of Mayo Hospital Lahore from Jan., 2007 to May 2007. All adult females having fasting blood sugar > 110 mg/dl, appearing for the regular check-ups at diabetic out patient clinic Mayo Hospital, were included in the study. All those who were eligible but PREVALENCE OF METABOLIC SYNDROME IN PRE AND POST MENOPAUSAL DIABETES 27 Biomedica Vol. 24 (Jan. Jun. 2008) did not give the informed consent were excluded. Data was collected for waist circumference (at narrowest point between umbilicus and rib cage), systolic and diastolic blood pressure, fasting level of triglycerides, high density lipoproteins and information about menstruation. Metabolic syndrome was characterized to be there when in addition to diabetes any two of the following were present2: 1. Blood pressure > 130/85. 2. Obesity or waist circumference>88 cm. 3. Triglycerides>150 mg/dl. 4. High density lipoproteins<50 mg/dl. Menopause was defined as complete cessation of menstruation for > 1 year without any surgical or medical intervention. Before menopause was defined as pre-menopause and when more than 1 year had passed after menopause was called postmenopause. Frequencies and percentages were calculated to report the objective of the study. We compared between pre and post menopausal diabetics for the differences in components of metabolic syndrome e.g., waist circumference, blood pressure, triglycerides, high density lipoproteins. The components of metabolic syndrome were assessed using chi-square test. Data was analysed using SPSS version 13. RESULTS During the study period 200 cases were included in the study after taking the informed consent. Among them 100 cases were pre-menopausal and the remaining were post-menopausal. Out of 200 cases, 60 cases were hypertensive (30%), 56 cases had waist circumference more than 88 cm (28%), 16 cases had triglycerides level more than 150 mg/ dl (8%) and 4 cases had high density lipoproteins less than 50 mg/dl (Table 1). Table 1: Distribution of components of metabolic syndrome other than diabetes. Components Standard value Cases Percentage Hypertension >130/85 60 30 Waist circumference >88 cm 56 28 Triglycerides >150 mg/dl 16 8 High density lipoproteins < 50 mg/dl 5 2 When distribution of components of metabolic syndrome other than diabetes were analysed, using standard cut off values, following results were obtained. A total of 68 (34%) cases had only one component of metabolic syndrome in addition to diabetes, 40 (20%) cases had two components of metabolic syndrome, 12 (6%) cases had three components of metabolic syndrome and 4 (2%) cases had all the components of metabolic syndrome. Thus 28% of the cases had two or more components of metabolic syndrome in addition to diabetes. According to ATPIII guidelines 28% cases in our study had metabolic syndrome (table 2). Table 2: Distribution of number of components of metabolic syndrome. Number of components Cases Percentage