Building Competency in Diabetes Education THE ESSENTIALS

PATHOPHYSIOLOGY| 3-17

Insulin resistance syndromes The following abnormalities include conditions where hyperglycemia is one of the diagnostic features.

Metabolic syndrome Metabolic syndrome (previously called Syndrome X) is also a disorder associated with type 2 diabetes. There is consensus on the following criteria for diagnosis, but not on the specific values associated with each criterion: insulin resistance, hypertension, dyslipidemia (including low high-density lipoproteins and high triglycerides) and central obesity (1). Insulin resistance is the most accepted unifying cause of this syndrome, although this needs to be further investigated (29). Table 3. Harmonized definition of metabolic syndrome: ≥ 3 measures to make the diagnosis of metabolic syndrome* Measure Categorical cutpoints Men Women Elevated waist circumference (population- and country-specific cutpoints): Canada, United States Europid, Middle Eastern, sub-Saharan African, Mediterranean Asian, Japanese, South and Central American ≥102 cm ≥94 cm ≥90 cm ≥88 cm ≥80 cm ≥80 cm

Elevated TG (drug treatment for elevated TG is an alternate indicator †)

≥1.7 mmol/L

Reduced HDL-C (drug treatment for reduced HDL-C is an alternate indicator †) Elevated BP (antihypertensive drug treatment in a patient with a history of hypertension is an alternate indicator)

<1.0 mmol/L in males <1.3 mmol/L in females

Systolic ≥130 mm Hg and/or diastolic ≥85 mm Hg

Elevated FPG (drug treatment of elevated glucose is an alternate indicator)

≥5.6 mmol/L

BP = blood pressure; FPG = fasting plasma glucose; HDL-C = high-density lipoprotein cholesterol; TG = triglycerides. ∗ Adapted from Alberti KGMM, Eckel R, Grundy S, et al. Harmonizing the metabolic syndrome. Circulation. 2009;120:1640-1645. †; The most commonly used drugs for elevated TG and reduced HDL-C are fibrates and nicotinic acid. A patient taking one of these drugs can be presumed to have high TG and reduced HDL-C. High-dose omega-3 fatty acids presumes high TG. Reprinted from Diabetes Canada 2018 Clinical Practice Guidelines (1)