incidence of metS in diabetic patients

A CROSS-SECTIONAL STUDY OF METABOLIC AND NON-METABOLIC SYNDROME IN TYPE 2 DIABETIC PATIENTS     : 

A CROSS-SECTIONAL STUDY OF METABOLIC AND NON-METABOLIC SYNDROME IN TYPE 2 DIABETIC PATIENTS By 10117D-3007 Pharm. D (P.B)-II year Under Guidance of Dr. Subash Vijay Kumar, M.Pharm. PhD, Dr. V. Chandrashekhar, M.D, Associate Professor, Professor, Department of Pharmacy Practice, Department of General Medicine, Vaagdevi College of Pharmacy. MGM Hospital, Warangal.

Introduction: 

Introduction Metabolic syndrome is constellation of conditions that place people at high risk for type II diabetes and cardiovascular disease. These conditions include obesity, high blood pressure , and a poor lipid profile with elevated LDL ("bad") cholesterol, low HDL ("good") cholesterol, elevated triglycerides.

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RISK FACTOR ATP III 3 out of 5 WHO IGT/IFG+2 IDF WAIST +2 AACE Waist circumference Men Women >90 cm >80 cm BMI>30 BMI>30 ≥90 cm ≥80 cm BMI>30 Triglycerides ≥150 mg/dL ≥150 mg/dL ≥150 mg/dL ≥150 mg/dL HDL cholesterol Men Women <40 mg/dL <50 mg/dL <35 mg/dL <39 mg/dL <40 mg/dL <50 mg/dL <40 mg/dL <50 mg/dL Blood pressure (mm Hg) ≥130/≥85 ≥160/≥90 ≥130/≥85 ≥130/≥85 Fasting glucose ≥100 mg/dL IGT/IFG ≥100 mg/dL ≥100 mg/dL Microalbumuniria ------ ≥ 20  g/min --------- ----------- MULTIPLE CRITERIA FOR METABOLIC SYNDROME

Need of the study : 

Need of the study The modern epidemics of type 2 DM and metabolic syndrome will increase premature death and disability, directly impacting and impeding the economic progress of the country. Control of these will need judicious use of scarce resources through primary and secondary preventive measures. Though the evidence for most of these interventions is clear from research studies, translation of this to community-based intervention is the next challenge for healthcare professionals and public-health experts .

Need of the study : 

Need of the study It appears that there is a rapid progression from a prediabetic state (represented by the metabolic syndrome) to fully developed diabetes, particularly among South Asians. The reasons for this are not clear and could be a subject for my study. Identification and evaluation of risk factors for controlling the rising burden of metabolic syndrome are needed globally.

Aims and objectives: 

Aims and objectives To look at the incidence of metabolic and non metabolic syndrome. To identify the incidence of major risk factor in patient characteristics. To examine the disease outcomes of patients. To examine the age related incidence of metabolic syndrome in type 2 diabetic patients. To assess the Patient’s leisure physical activity and body mass index (BMI).

Aims and objectives: 

Aims and objectives To determine the incidence of metabolic syndrome according to lifestyle pattern Vs category of job. To evaluate the drug utilisation of drugs for patients with type2 diabetes. To investigate the laboratory clinical parameters of patients. To assess the socio demographic of the patients.

MATERIALS AND METHODS: 

MATERIALS AND METHODS A cross sectional study was conducted for a period of 6 months (January 2011 to June 2011). The inclusion criteria were Age>18 years and patients who attended the Diabetic Out Patient (OP) Clinic. Exclusion criteria were endocrine disease, such as cushing‟s disease, type-1 diabetes mellitus, acromegaly, hypothyroidism, hypogonadism, patient on prolong steroid use and those who were on active drug treatment for obesity at the time of admission.

MATERIALS AND METHODS: 

MATERIALS AND METHODS Proforma includes co-morbidities, characteristics, details of physical and biochemical information and treatment, where reviewed and recorded. Physical and biochemical measurements used in the study were measured taken on the first visit. Independent variables of interest are age, gender, smoking, alcoholic consumption, family history of diabetic types. Drug utilization Pattern by using WHO Core Prescribing Indicators.

Results : 

Results Total number of population : 275 Patients eligible for the study: [75 (MetS-55, Non-MetS-20)] The overall incidence of the study : 73.33% Gender wise distribution: Male: 54.83%, Female: 45.27% Age wise distribution:

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PREVALENCE OF METABOLIC SYNDROME IN GENDER WISE DISTRIBUTION

PowerPoint Presentation: 

Age METABOLIC SYNDROME (55) NON METABOLIC SYNDROME (20) G roups Male (43) Female (12) Total (55) Mean P Value Male (13) Female (7) Total (20) Mean P Value ≤18 yrs 0 (0%) 0 (0%) 0 (0%) ------ ------- 0 (0%) 0 (0%) 0 (0%) ------ ------- 18-30 yrs 2(4.65%) 0 (0%) 2(3.63%) 29±1.414 0.0219 0 (0%) 1 (14.2%) 1 (5%) ------ ------- 31-40 yrs 7(16.27%) 1(8.33%) 8(14.6%) 37.75±1.20 0.0001 2 15.3%) 1 (14.2%) 3 (15%) 35±0.10 0.0003 41-50 yrs 10(23.25%) 3 (25%) 13(23.6%) 46.77±2.74 0.0001 4(30.7%) 1 (14.2%) 5 (25%) 46.6±2.30 0.0001 51-60 yrs 13(30.23%) 6 (50%) 19(34.8%) 55.58±3.115 0.0001 5(38.5%) 1 (14.2%) 6 (30%) 56.33±2.94 0.0001 61-70 yrs 9(20.9%) 2(16.6%) 11(20%) 65.45±1.8 0.0001 2(15.5%) 3 (42.8%) 5 (25%) 65.4±0.89 0.0001 71-80 yrs 2(4.65%) 0 (0%) 2(3.63%) 75±1.414 0.0085 0 (0%) 0 (0%) 0 (0%) ------ -------- PREVALENCE OF METABOLIC SYNDROME ACCORDING TO AGE WISE

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CATEGORY METABOLIC SYNDROME (55) NON METABOLIC SYNDROME (20) Male Female Total Percentage Male Female Total Percentage 43 12 55 73.33 13 7 20 26.66 PLACE Rural 16 (37.3%) 7 (58.3%) 23 41.88 7 (53.8%) 4 (57.1%) 11 55 Urban 27 (62.7%) 5 (41.7%) 32 58.22 6 (46.2%) 3 (42.9%) 9 45 EDUCATION STATUS 1-5 6 (13.95%) 0 (0%) 6 11 2 (15.38%) 0 (0%) 2 10 6-10 12 (27.90%) 3 (25%) 15 27 3 23.07%) 4 (57.14%) 7 35 Inter 5 (11.62%) 1 (8.33%) 6 11 1 (7.69%) 1 (14.28%) 2 10 Degree 3 (6.97%) 0 (0%) 3 5.45 4 (3.76%) 1 (14.28%) 5 25 PG 2 (2.32%) 0 (0%) 2 3.63 0 (0%) 0 (0%) 0 0 Illiterate 15 (34.8%) 8 (66.6%) 23 41.8 3 (23.07) 1(14.28%) 4 20 RELIGION Hindu 33 (76.7%) 8 (66.6%) 41 74.5 8 (61.5%) 6 (85.7%) 14 70 Muslim 6 (13.9%) 3 (25%) 9 16.3 3 (23%) 1 (14.2%) 4 20 Christian 4 (9.4%) 1 (8.4%) 5 9.2 2 (15.5%) 0 (0%) 2 10 SOCIO DEMOGRAPHIC STATUS

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Social habits METABOLIC SYNDROME (55) NON METABOLIC SYNDROME (20) Smoking Male (43) Female (12) Total (55) Percentage Male (13) Female (07) Total (20) Percentage Current 11 (25.58%) 0 (0%) 11 20.8 1 (7.69%) 0 (0%) 1 5 Past 8 (18.60%) 2 (16.66%) 10 18.18 3 (23%) 0 (0%) 3 15 None 24 (55.81%) 10 (83.33%) 34 61.8 9 (69.23%) 7 (100%) 16 80 Alcohol Drinking Current 22 (51.1%) 1 (8.33%) 23 41.81 4 (30.7%) 0(0%) 4 20 Past 4 (9.3%) 2 (16.66%) 6 10.9 5 (38.4%) 1 (14.2%) 6 30 None 17 (39.5%) 9 (75%) 26 47.2 4 (30.7%) 6 (85.7%) 10 50 SOCIO DEMOGRAPHIC STATUS

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Marital status METABOLIC SYNDROME (55) NON METABOLIC SYNDROME (20) Male (43) Female (12) Total (55) Percentage Male (13) Female ( 07) Total (20) Percentage Married 43(100%) 10 (83.3%) 53 96.4 13 (100%) 7 (100%) 20 100 Unmarried 0 (0%) 2 2 3.6 0 (0%) 0 (0%) 0 0 Physical exercise Severe 1 (2.32%) 0 (0%) 1 1.82 1 (7.7%) 1 (14.28%) 2 10 Mild to moderate 18 (42%) 1 (8.33%) 19 34.5 4 (30.77%) 3 (42.86%) 7 35 Sedentary 24 (56%) 11 (91.66%) 35 63.6 8 (61.5%) 3 (42.8%) 11 55 SOCIO DEMOGRAPHIC STATUS

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Mean METABOLIC SYNDROME (55) NON METABOLIC SYNDROME (20) Male (43) Female (12) Mean ±S.D P Value Male (13) Female (07) Mean ±S.D P Value W.C 92.9 92.95 92.7±10.3 < 0.201 87.8 82 84.9±8.25 <0.0001 BMI 25 25.09 25±4.004 <0.0001 23.52 24.81 24.17±2.63 <0.0001 TG 186.2 186 186±76.5 <0.0001 126.94 185.82 156.8±75.43 <0.0001 HDL 22.77 22.7 23.7±10.1 <0.0001 35.54 32.40 33.4±15.59 <0.0001 SBP 130 130 130±13.71 <0.0001 120 117.42 118±7.95 <0.0001 DBP 83.93 85.83 84.3±7.65 <0.0001 80 75.71 77.86±5.53 <0.0001 FBS 109 140.6 116.1±55.4 <0.0001 116.02 107.14 111.58±34.6 <0.0001 Age 52.6 53.3 52.8±11.16 <0.0001 51.8 50.71 51.23±12 <0.0001 Duration of diabetes 6.47 6.75 6.52±97.5 <0.0001 4.6 5 4.8±47.24 <0.0001 COMPARISION OF MEAN OF CLINICAL PARAMETERS IN DIFFERENCE WITH AND WITHOUT METABOLIC SYNDROME TG= Triglycerides; H.D.L = High Density Lipoproteins; S.B.P= Systolic Blood Pressure; D.B.P= Diastolic Blood Pressure; W.C= Waist Circumference; B.M.I=Body Mass Index; F.B.S=Fasting Blood Glucose

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PARAMETES Metabolic syndrome (55) Non Metabolic syndrome (20) Rural (23) Urban (32) Rural (11) Urban (09) Male Female Total Male Female Total Male Female Total Male Female Total W.C 13 4 17 15 6 21 4 0 6 2 2 4 TG 13 3 16 14 5 19 1 0 1 1 3 4 HDL 18 4 22 22 7 29 6 2 8 2 2 4 S.B.P 13 2 15 17 4 21 2 0 2 1 2 3 D.B.P 7 2 9 11 4 15 0 0 0 2 0 2 F.B.G 11 4 15 6 5 11 5 1 6 2 2 4 COMPONENTS OF THE METABOLIC AND NON METABOIC SYNDROME IN GENDER AND LIVING AREA TG= Triglycerides; H.D.L = High Density Lipoproteins; S.B.P= Systolic Blood Pressure; D.B.P= Diastolic Blood Pressure; F.B.G=Fasting Blood Glucose; W.C= Waist Circumference;

family history: 

family history

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Clinical parameters Metabolic syndrome (55) Non Metabolic syndrome (20) Non-young (>45 years) Young (< 45 years) Non young (>45 years) Young (<45 years) M F T M F T M F T M F T TG (≥150 mg/dL) 16 7 23 11 1 12 1 3 4 0 2 2 HDL ( 40 mg/dL) 30 7 37 11 2 13 5 3 8 4 2 6 S.B.P(≥130 mmHg) 22 4 26 8 2 10 2 1 3 1 1 2 D.B.P(≥85 mm Hg) 17 5 22 3 2 5 2 0 2 0 0 0 Smoking 7 0 7 2 0 2 1 0 1 3 0 3 Alcohol 9 1 10 1 0 1 7 0 7 2 1 3 Vegetarian 1 0 1 0 0 0 0 0 0 0 0 0 Non – vegetarian 30 9 39 12 13 15 9 4 13 4 3 7 W.C 19 8 27 8 2 10 6 2 8 0 0 0 TG= Triglycerides; H.D.L = High Density Lipoproteins; S.B.P= Systolic Blood Pressure; D.B.P= Diastolic Blood Pressure; W.C= Waist Circumference; M=Male; F=Female COMPARISION OF CLINICAL AND NON CLINICAL PARAMETERS OF YOUNG AND NON YOUNG PATIENTS IN PATIENTS WITH METABOLIC AND NON METABOLIC SYNDROME

age related co-morbidities: 

age related co-morbidities

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S.No Indicators Data Prescribing indicators 01 Average drugs Prescribed 240/55= 4.35 02 Generics 112=46.66%drugs per prescription 03 Antibiotics 7/55=0.12 rugs per prescription 04 On essential drug list 85% Patient care Indicators 05 Average Consulting time 5 minutes 06 Average Dispensing time 300 sec 07 Drugs Dispensed 92% 08 Adequate Knowledge Moderate Facility Indicators 09 Availability of EDL Yes 10 Key Drugs Available 92% Complementary Indicators 11 Without drugs 08% 12 Average Drugs cost(Rs/Prescription) ------ 13 Drug Cost On Injections ------ 14 Percent of combination drugs per Prescription 12% 15 Percent Of Prescriptions with at least one injection 0% 16 Percent vitamins/tonics per prescription 7.636% WHO CORE PRESCRIBING INDICATORS OF METABOLIC SYNDROME PATIENTS IN MGM HOSPITAL

OUTCOME OF THE TREATMENT : 

OUTCOME OF THE TREATMENT METABOLI C SYNDROME NON METABOLI C SYNDROME

prevalence of individual risk factors in patients with metabolic syndrome: 

prevalence of individual risk factors in patients with metabolic syndrome

PowerPoint Presentation: 

DURATION METABOLIC SYNDROME (55) NON METABOLIC SYNDROME (20) Male (43) Female (12) Total (55) P Value Male (13) Female (7) Total (20) P Value Current 2 (4.65%) 0 (0%) 2 (3.63%) <0.0001 0 (0%) 0 (0%) 0 (0%) ---------------- 1 -3 months 3 (6.97%) 0 (0%) 3 (5.45%) <0.0001 1 (7.69%) 0 (0%) 1 (5%) --------------- 3 – 11 months 9 (20.9%) 3 (25%) 12 (22.2%) <0.0001 3 (23%) 0 (0%) 3 (15%) ˂0.0377 1-5years 15(34.8%) 6 (50%) 21 (38.1%) <0.0001 4 (30.7%) 5 (71.4%) 9 (45%) ˂0.0001 6-10 years 6 (13.9%) 1 (8.33%) 7 (12.72%) <0.0001 4 (30.7%) 1 (14.28%) 5 (25%) ˂0.0001 11-15 years 1 (2.32%) 1 (8.33%) 2 (3.63%) <0.0001 1 (7.69%) 1 (14.28%) 2 (10%) ˂0.0236 16-25years 5 (11.6%) 1 (8.33%) 6 (10.9%) <0.0001 0 (0%) 0 (0%) 0(0%) ------------- 26-35 years 2 (4.65%) 0(0%) 2 (3.63%) <0.0001 0 (0%) 0 (0%) 0 (0%) ------------ DURATION OF DIABETES

PowerPoint Presentation: 

TOP TWELVE DRUGS UTILIZED CONCOMITANTLY IN PATIENTSWITH METABOLIC SYNDROME

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INCIDENCE OF METABOLIC SYNDROME ACCORDING TO LIFE STYLE PATTERN

discussion: 

discussion The findings of present study, the incidence of Met S in male was significantly higher than in female. This is due to more overweight patients, aging, increased waist circumference, dyslipidemia, sedentary life style higher in male than female. It is contrary to these finding, a study in Iran Met S found a significantly higher in female than in male the very low levels of physical activity in women than in men. Nizal et al. metabolic syndrome: An emerging public health problem in Iranian women: International Journal of Cardiology 131 (2008) 90-96

discussion: 

discussion In our study the MetS was more prevalent in urban areas. This finding is similar to recent surveys in china and Greece showing a higher prevalence of the MetS in urban compared to rural residents. Gu D, Reynolds K, WUX, et al. for the inter ASIA collaborate group prevalence of the MetS and overweight among adults in China, Lancet 2005; 365: 1398-405. Athyros VG, Bouloukos VI, Pehlivanidis AN et al . the prevalence of the MetS in Greece. The MetS Greece multicentre study. Diabetes Obes Metab 2005; 7: 397-405

discussion: 

discussion Abdominal obesity was common in South Asians and evident in non-obese people. They have high percentage of body weight, thick subcutaneous adipose tissue, low muscular mass, insulin resistance, hyperinsulinaemia. This body composition is conductive to the development of metabolic syndrome . It is similar to our study . Misra et al . The metabolic syndrome in South Asians in Type 2 diabetes in South Asians: epidemiology, risk factors and prevention. 2006: 76-95 .

discussion: 

discussion We found that high prevalence of MetS was primarily indicated by central obesity combined with dyslipidemia (low HDL, high TG and HTN). The high prevalence of hypertriglyceridemia notably in men might be due to the sedentary life style. This finding was contrast to the previous researcher. Faeh D, Bopp M. Proposed obesity body mass index correction for self-reported data may not be appropriate. J Epidemiol Community Health 2009; 63:863-864.

discussion: 

discussion Moreover, the triglycerides were elevated and HDL levels reduced in patients with metabolic syndrome when compared to non-metabolic syndrome patients. Hence our results emphasize on prescription of hyperlipidaemic drug to the MetS patients to prevent further complications .

conclusion: 

conclusion In summary, this cross-sectional study characterize the metabolic Vs non-metabolic syndrome of type2 diabetes, should generate a biological resource to enable further investigation. Our results suggest that prevalence of metabolic syndrome was observed in non-obese patient and was higher in male patients and was positively correlated with aging. Nevertheless further studies are required to validate the metabolic syndrome in larger population.

references: 

references Alberti, K.G. et al. (2006) Metabolic syndrome – a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med 23: 469–480. Basit, A et al . (2008 ) Prevalence of metabolic syndrome in Pakistan. Metabol Syndr Relat Disord 6: 171-5 Fonseca,V.A. (2005) The metabolic syndrome, hyperlipidemia, and insulin resistance. Clin Cornerstone 7: 61–72 . Ford, E.S. et al. (2004) Increasing prevalence of the metabolic syndrome among U.S. Adults. Diabetes Care 27: 2444–2449.

references: 

references Lu B et al .(2006) An evaluation of the International Diabetes Federatio definition of the metabolic syndrome in Chinese patients older than 30 years and diagnosed with type 2 diabetes mellitus. Metabolism 55 : 1088-96 Misra et al .(2006) The metabolic syndrome in South Asians in Type 2 diabetes in South Asians: epidemiology, risk factors and prevention. New Delhi : Jaypee 76-95 Wannamethee et al. (2005) Metabolic syndrome vs Framingham Risk Score for prediction of coronary heart disease, stroke, and type 2 diabetes mellitus. Arch Intern Med ;165(22):2644-2650

Publication and conference: 

Publication and conference Nagesh . A, Chandrashekar V. Vijayakumar.S “Incidence of metabolic syndrome in Patients with Type 2 diabetic Patients.” 2011; RIPER: July 8-9. Subash Vijaya Kumar, A.Nagesh, M. Leena, G. Shravani, V.Chandrasekar. Incidence of metabolic syndrome and its characteristics of patients attending an diabetic outpatient clinic in a teritary care hospital 2011: Journal of Natural Science, Biology and Medicine. accepted.

Publication and conference: 

Publication and conference Dear Mr. Subash , We are pleased to inform that your manuscript " INCIDENCE OF METABOLIC SYNDROME AND ITS CHARACTERISTICS OF PATIENTS ATTENDING AN DIABETIC OUTPATIENT CLINIC IN A TERITARY CARE HOSPITAL " is now acceptable after clearing the dues for publication of the manuscript. The payment for author-side fee can be done online through credit card or by a cheque. Please visit the journal's manuscript submission system and login into your account for the details Once the payment is received at our end, the manuscript would be processed further and you would receive an edited version of article in about 2-3 weeks from now for a final check and correction. We thank you for submitting your valuable research work to Journal of Natural Science, Biology and Medicine. With warm personal regards, Yours sincerely, Arun HS Kumar Journal of Natural Science, Biology and Medicine

Patient profile form: 

Patient profile form Name Age Sex Ip. No Date Place Occupation married Co - Morbidities Physical history Social history Ht: Wt: BMI: Smoking Alcohol Others UW/OW/NW/Obese Current/past/none Current/past/non Tobacco/pan/ gutka Literate/Illiterate Religion: Hindu/Muslim/Christian Food habits: Veg/Non-Veg Department Duration of diabetes Smoking age: started___stopped___ Duration of smoking Type of tobacco taken: Smoking/Smokeless Physical activity : Vigorous exercise/Mild to Moderate exercise/ No exercise and Sedentary exercise Family history: no family history/father/mother/both Clinical features present: Type of education: 1 2 3 4 5 6 7 8 9 10 11 12 degree PG any other Medication S.No Drugs Dose Frequency Route of Administration Risk factors S.No Risk factor Defining level Patient level 01. Waist circumference Men>90 cm Women>80 cm 02. Triglycerides ≥150 mg/dL 03. HDL cholesterol Men<40 mg/dL women<50 mg/dL 04. Blood pressure ≥130/≥85 mm Hg 05. Fasting glucose ≥110 mg/dL

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Thank you