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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetes mellitus is associated with a markedly increase prevalence of coronary artery disease, found to be as high as 55% (Lyons, 1993). The metabolic syndrome X, a multifaceted clinical entity produced by genetic, hormonal and lifestyle factors which occurs frequently in the general population, has been associated as an end point in patients with diabetes (Timar, Sestier et al., 2000). New data suggests that a clustering of truncal obesity, glucose intolerance or non-insulin dependent diabetes mellitus, dyslipidemia and essential hypertension are key components of this metabolic syndrome X (Timar, Sestier et al., 2000). In fact, the metabolic syndrome X has been shown to precede frank diabetes in a substantial number of patients; hence similar multiple cardiac risk factors will be found in this population. Thus, primary care providers should identify patients at an early stage so that appropriate treatment can be readily instituted. The goal of this review is to summarize criteria for diagnosis of patients with the metabolic syndrome X and therapeutic targets of each individual component is analyzed in a attempt to reduce cardiovascular events and improve clinical outcome based on the available clinical data.
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PMID:Metabolic syndrome X: a comprehensive review of the pathophysiology and recommended therapy. 1195 75

Metabolic Syndrome X is a clinical entity which comprises the following factors: diabetes mellitus, arterial hypertension, high levels of triglyceride and/or low levels of HDL cholesterol, central obesity and microalbuminuria (by WHO criteria). The first goal of this study was to determine the frequency of the Metabolic Syndrome X (MSX) in patients with acute myocardial infarction compared with the general population. The second goal of the study was to examine the frequency of heart failure and reinfarction rate in the patients with myocardial infarction, with and without MSX. Furthermore, the relationship between gender and MSX was analyzed. A total of 101 patients with acute myocardial infarction took part in randomized trial (32 women and 69 men). MSX and all of its components were diagnosed according to WHO criteria. To determine statistical significance of our results, we used chi2 test and t-test for independent samples. From 101 patient 48 had MSX (47.52%), while in the general population incidence of MSX is 3-4%. The reinfarction and the heart failure rate were significantly higher in the group of patients with MSX (p = 0.0067 and p = 0.0217, respectively). To conclude, the results of the present study confirm that MSX is a high risk factor for myocardial infarction and its complications.
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PMID:Metabolic syndrome X--high risk factor for acute myocardial infarction and its complications. 1213 4

The metabolic syndrome X and Cushing's syndrome show similar symptoms but one major difference: Plasma cortisol is not elevated in the metabolic syndrome. Evidence is presented, that by the action of 11 beta-hydroxysteroid dehydrogenase 1 (11 beta HSD1) higher intracellular cortisol concentration may be created that may be relevant to induce insulin resistance and metabolic disturbances. Regulation of 11 beta HSD1 expression by hormones, growth factors, cytokines and transcription factors enables tissue specific adjustments of glucocorticoid receptor activation by cortisol. Specific inhibition of 11 beta HSD1 would help to understand aspects of the pathogenesis of syndrome X and to develop new therapeutic perspectives.
Exp Clin Endocrinol Diabetes 2002 Oct
PMID:The metabolic syndrome X and peripheral cortisol synthesis. 1239 28

The precise molecular cause of insulin resistance has not yet been elucidated. Resistance to the normal action of insulin contributes to the pathogenesis of a number of common human disorders, including type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus, hypertension, and the Metabolic Syndrome X, thus constituting a major public health problem. A disease program aimed at combating this disorder should focus on the identification of targets for therapeutic intervention which may overcome insulin resistance and hence the associated metabolic consequences characteristic of the Metabolic Syndrome. Although the primary defect in the pathogenesis of type 2 diabetes is unknown, genetic and environmental factors are likely to contribute to the manifestation of this progressive metabolic disorder, which is usually not clinically apparent until mid-life. Defects at the level of glucose uptake/phosphorylation characterize insulin resistance in skeletal muscle of type 2 diabetic patients. Identification of putative components of the insulin receptor-signaling pathway may offer insights into mechanisms involved in insulin resistance. Enhanced flux of free fatty acids due to impaired lipid metabolism may contribute to impaired insulin secretion and peripheral insulin resistance. Genes regulating lipolysis are prime candidates for susceptibility towards the metabolic syndrome. Here we describe pathways constituting complex interactions that control glucose homeostasis. We will be considering (1) regulation of glucose uptake by the insulin receptor signaling pathway, and (2) control of adipogenesis and insulin sensitivity by the sterol response element binding protein (SREBP) pathway.
Exp Clin Endocrinol Diabetes 2003 Jun
PMID:Analysis of insulin signaling pathways through comparative genomics. Mapping mechanisms for insulin resistance in type 2 (non-insulin-dependent) diabetes mellitus. 1284 56

The aim of this article is to summarize and critique reports from selected large-scale population health surveys (U.S. and Canada national health surveys (e.g., National Health and Nutrition Examination Survey, Youth Risk Behavior Survey, and Canada Fitness Survey), and active research programs in preventive pediatric cardiology (i.e., Bogalusa Heart Study, Princeton Lipids Study, and Minneapolis Blood Pressure Study)) pertaining to the secular trend in variables associated with the metabolic syndrome of North American youth. These surveys were chosen since they have published peer-reviewed articles on the topic and consist of relatively large samples. The increased body mass index and prevalence of overweight and obesity are clear, particularly over the past two decades. The secular increase in overweight and obesity cannot be linked to available self-report data on physical activity or diet, although measurement issues need to be considered. The emergence of Type II diabetes in adolescents parallels the increase in obesity; however, subsequent changes in blood lipids and blood pressure are less clear. There is some evidence to suggest adverse changes in the blood lipid profile. Aerobic fitness, as determined by maximal oxygen consumption (VO(2max)), has not appeared to change in youth except perhaps for adolescent females. The results suggesting the emergence of metabolic syndrome X during childhood and adolescence are discussed in the context of perturbation and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. It can be suggested that a subsistent lifestyle consisting of increased lifestyle activity (not exercise per se), a prudent diet, adequate sleep and rest, and stress reduction be advocated to combat diseases of Western Civilization/metabolic syndrome that have affected North American children (and adults) in recent years. The results also highlight the importance of population surveillance of obesity, physical activity, and dietary intake and cardiovascular health of children into the 21st century.
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PMID:Secular trends in variables associated with the metabolic syndrome of North American children and adolescents: a review and synthesis. 1459 70

Subclinical Cushing's syndrome (SCS) caused by adrenal incidentalomas is frequently associated with overweight and insulin resistance. Metabolic syndrome X may therefore be a clue to the presence of CS. However, the incidence of CS in this situation remains unknown. We have conducted a prospective study to evaluate the prevalence of occult CS in overweight, type-2 diabetic patients devoided of specific clinical symptoms of CS. Two hundred overweight, type-2 diabetic patients, consecutively referred for poor metabolic control (HbA(1C) > 8%), were studied as inpatients. A first screening step was performed with the 1-mg overnight dexamethasone suppression test (DST) using a revised criterion for cortisol suppression (60 nmol/liter) to maximize the sensitivity of the procedure. A second confirmatory step of biochemical investigations (midnight plasma cortisol concentration, plasma cortisol circadian rhythm, morning plasma ACTH concentration, 24-h urinary free cortisol, and 4-mg i.v. DST) was performed in patients with impaired 1-mg DST. A third step of imaging studies was performed according to the results of second-step investigations. Fifty-two patients had impaired 1-mg DST. Among these, 47 were further evaluated. Thirty were considered as false positives of the 1-mg DST, whereas 17 displayed at least one additional biological abnormality of the hypothalamic-pituitary-adrenal axis. Definitive occult CS was identified in four patients (2% of the whole series) with Cushing's disease (n = 3) and surgically proven adrenal adenoma (n = 1). Definitive diagnosis remains to be established in seven additional patients (3.5%) with mild occult CS associated with unsuppressed plasma ACTH concentrations and a unilateral adrenal tumor of 10-29 mm in size showing prevalent uptake at radiocholesterol scintigraphy. In conclusion, a relatively high prevalence of occult CS was found in our study. Further studies are needed to evaluate the impact of the cure of occult CS on obesity and diabetes mellitus in these patients. Such studies might provide a rationale for systematic screening of occult CS in this population.
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PMID:Occult Cushing's syndrome in type-2 diabetes. 1467 Nov 73

Hypertension in combination with clinically overt diabetes mellitus is recognized as a particularly powerful combination of risk factors that greatly increases cardiovascular vulnerability. There is also evidence that presumed pre-diabetic conditions such as insulin resistance, hyperinsulinaemia and compensatory hyperglycaemia may amplify overall cardiovascular risk in patients with hypertension, especially when encountered as part of the condition known as metabolic syndrome X (Reaven's syndrome). The long-term benefits of antihypertensive therapy may be compromised if these drugs exert adverse effects on metabolic parameters such as insulin sensitivity, or if they promote a transition from pre-diabetes to overt diabetes. Class differences in the effects of antihypertensives on metabolic indices may therefore be an important consideration when choosing treatment for patients who exhibit these characteristics. Experience from clinical trials suggests that drugs that target the renin-angiotensin system may have metabolic advantages over drugs such as beta-blockers and diuretics, but this conclusion has not been proved definitively. Moxonidine, which selectively targets imidazoline type-1 receptors in the sympathetic vasomotor centres of the rostral-ventrolateral medulla, is an effective antihypertensive and has been reported to exert favourable metabolic effects in preclinical and clinical studies. The MARRIAGE study (Moxonidine And Ramipril Regarding Insulin And Glucose Evaluation) will extend these preliminary observations by comparing the effects of moxonidine and the ACE inhibitor ramipril--and the combination of both drugs--on metabolic and haemodynamic parameters in patients with hypertension and impaired fasting glycaemia. A description is provided of the design and conduct of MARRIAGE.
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PMID:Selective imidazoline agonist moxonidine plus the ACE inhibitor ramipril in hypertensive patients with impaired insulin sensitivity: partners in a successful MARRIAGE? 1502 45

Metabolic syndrome represents a cluster of clinical, biochemical and humoral abnormalities associated with impaired insulin action in glucose metabolism. In the literature also the term syndrome of insulin resistance, dysmetabolic syndrome X, Reaven syndrome or Kaplans dead quartet can be found. Hyperinsulinaemia, central obesity, essential hypertension, dyslipidaemia, impaired glucose homeostasis or type 2 diabetes, hyperuricaemia, hypercoagulable state, endothelial dysfunction and increased markers of inflammation such as C-reactive protein, selectines, adhesion molecules, pro-inflammatory cytokines are the typical components of metabolic syndrome increasing the risk of cardiovascular complications. List of currently recognized clinical and biochemical manifestations continues to expand and include also non-alcoholic steatohepatitis, polycystic ovaric syndrome (PCOS), hyperhomocysteinaemia and others. No standard definition of metabolic syndrome has been routinely used. The WHO initially proposed a definition of metabolic syndrome in 1998, and more recently NCEP-ATP III provided a new working definition in 2001, which is more suitable for clinical practice. Prevalence of metabolic syndrome is very high, about 25-30% in Caucasians, depending on diagnostic criteria used. The clinical significance of metabolic syndrome is augmented by its association with increased and accelerated atherosclerosis. Whether IR predicts cardiovascular disease (CVD) independently of diabetes and other CVD risk factors is still a matter of controversy. Recently there is a growing evidence that metabolic syndrome increases also the risk of all-cause mortality and risk of certain tumors.
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PMID:[The metabolic syndrome]. 1504 Jan 52

Advances in the management of the mother with diabetes have reduced the rate of morbidity and mortality for her infant. Aggressive control of maternal glycemic status is warranted, because most morbidities are epidemiologically and pathophysiologically closely linked to fetal hyperglycemia and hyperinsulinemia. The burgeoning public health problem of overweight and obesity in children will likely result in an increased incidence of metabolic syndrome X, characterized by insulin resistance and type II diabetes in adulthood. An early manifestation of this may be glucose intolerance during pregnancy in overweight women without diabetes. Clinicians must continue to have a high degree of suspicion for the diagnosis of diabetes during gestation and screen offspring of women with gestational diabetes for neonatal sequelae.
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PMID:Infants of diabetic mothers. 1515 88

The authors present the history of selecting and understanding the essence of the metabolic syndrome (X syndrome, Reaven's syndrome) related to insulin resistance as well as its contemporary working definition allowing diagnosing affected individuals. They describe the cycle of their own study investigating the prevalence of metabolic syndrome elements in patients treated because of their thyrotoxicosis. It has been observed that 4 weeks after thyrostatic treatment is started, many of these patients are affected by the growth of their body mass and total cholesterol level (mostly at the cost of LDL-cholesterol). After 2 years the growth of body mass is significant, many patients develop arterial hypertension. After 15 years of obesity, diabetes type 2 (DM-2), arterial hypertension, dyslipidemia, hyperinsulinaemia and full metabolic syndrome are found much more frequently than in the control group. In the research carried in the 1987--1989 period, we found the following in 11,546 subjects from the Lublin region (villagers aged over 18): overweight in 36% women and 34% of men, and obesity in 30% of women and 10% of men, and arterial hypertension in 24.2% and DM 2 in 2.7% of the whole examined group. Within the research carried out between 1998 and 2000 we examined 3,782 persons (63%) out of 6,000 persons aged over 35 carefully selected from the Lublin town and the Lublin region villages. DM 2 was found in 17.6% of the examined in the countryside and in 14.1% from the town (newly diagnosed diabetes--75% and 56% respectively). Obesity (BMI > or = 30 kg/m2) was found in 30.8% of the examined from villages and 30.1% town dwellers, arterial hypertension (RR > or = 140/90 mmHg) was found in 69.4% villagers and 68.6% subjects from the town. Total serum cholesterol > or = 5.2 mmol/l (200 mg/dl) was found in 66.4% of the examined from the countryside and in 60% from the town, LDL-cholesterol > or = 3.5 mmol/l (135 mg/dl) was found in 57.3% and 52.6% respectively, and triglycerides > or = 1.7 mmol/l (150 mg/dl) in 33,3% and 44.8 respectively. Hypo-HDL-cholesterolaemia was found in 21.7% of the examined from villages and in 31.4% of the examined from Lublin. 76.5% of the examined from the countryside and 72.7% from the town had a raised WHR index.
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PMID:Metabolic syndrome. 1531 27


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