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Diabetes & Metabolic Syndrome

Landmark Articles

Emerging therapeutic approaches for the management of diabetes mellitus and macrovascular complications.
By: Golden SH.
Type 2 DM affects an estimated 26 million people in the U.S. and is the 7th leading cause of death. While effective therapy can prevent or delay the complications that are associated with diabetes, according to the Center for Disease Control, 35% of Americans with DM are undiagnosed, and another 79 million Americans have blood glucose levels that greatly increase their risk of developing DM in the next several years. This article reviews established and emerging therapeutic approaches for managing DM and prevention of macrovascular complications.
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The relationship of insulin resistance and extracoronary calcification in the multi-ethnic study of atherosclerosis.
By: Tison GH, Blaha MJ, Budoff MJ, Katz R, Rivera JJ, Bertoni AG, Wong ND, Blumenthal RS, Szklo M, Eng J, Tracy R, Nasir K.
We hypothesized that insulin resistance, measured by the homeostasis model assessment of insulin resistance (HOMA-IR), is independently associated with prevalent and incident extra-coronary calcification (ECC). We concluded that HOMA has a positive and graded association with ECC, but not independently of cardiovascular risk factors, particularly metabolic syndrome components.
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Impaired fasting glucose and the risk of incident diabetes mellitus and cardiovascular events in an adult population: MESA (Multi-Ethnic Study of Atherosclerosis).
By: Yeboah J, Bertoni AG, Herrington DM, Post WS, Burke GL.
The purpose of the study was to assess the cardiovascular risk of impaired fasting glucose (IFG). The associations between IFG, incident type 2 diabetes mellitus (T2DM), and CV events remains unclear. The MESA study included participants who were 45 to 84 years or age and free of clinical CV disease at baseline. Having IFG was not independently associated with an increased short-term risk for incident CV events. These data reiterate the importance of intervention for persons with IFG to reduce their incidence of T2DM.
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Metabolically benign obesity: a wolf in sheep’s clothing.
By: McEvoy JW, Blaha MJ, Nasir K.
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Usefulness of baseline obesity to predict development of a high ankle brachial index (from the Multi-Ethnic Study of Atherosclerosis).
By: Tison GH, Ndumele CE, Gerstenblith G, Allison MA, Polak JF, Szklo M.
An abnormally high ABI is associated with increased all-cause and cardiovascular mortality. The relation of obesity to incident high ABI has not been characterized. The aim of this study was to investigate the hypothesis that increased obesity — quantified by body weight, body mass index, waist circumference, and waist-to-hip-ratio — is positively associated with a high ABI (?1.3) and with mean ABI increases over a 4-year follow-up. Independent, positive, and graded associations of increasing obesity with prevalent and incident high ABI and with mean increases in ABI values over time were found. Weight and body mass index seemed to be at least as strongly, if not more strongly, associated with a high ABI than were measures of abdominal obesity.
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he relationship between insulin resistance and incidence and progression of coronary artery calcification: the Multi-Ethnic Study of Atherosclerosis (MESA).
By: Blaha MJ, DeFilippis AP, Rivera JJ, Budoff MJ, Blankstein R, Agatston A, Szklo M, Lakoski SG, Bertoni AG, Kronmal RA, Blumenthal RS, Nasir K.
We sought to determine whether insulin resistance predicts the incidence and progression of CAC. We studied 5,464 MESA participants not on hypoglycemic therapy. Each had baseline HOMA-IR and baseline and follow-up CAC scores. Incident CAC was defined as newly detectable CAC; progression was defined as advancing CAC volume score at follow-up. HOMA-IR predicts CAC incidence and progression, but not independently of metabolic syndrome.
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Biological basis of depression in adults with diabetes.
By: Champaneri S, Wand GS, Malhotra SS, Casagrande SS, Golden SH.
Diabetes and depression are common comorbid conditions. Although certain health behaviors and risk factors partially explain the association of depression and diabetes, other potential mechanisms have yet to be elucidated. The objectives of this review were to summarize and review the recent evidence showing alterations of these three biological systems—HPA axis, SNS, and inflammatory cascade—in depression, diabetes, and diabetes-related risk factors.
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Abdominal obesity in rheumatoid arthritis: association with cardiometabolic risk factors and disease characteristics.
By: Giles JT, Allison M, Blumenthal RS, Post W, Gelber AC, Petri M, Tracy R, Szklo M, Bathon JM.
Abdominal adiposity, especially visceral adiposity, is emerging as a recognized cardiometabolic risk factor. This study was undertaken to investigate how abdominal fat is distributed in rheumatoid arthritis (RA), and its RA-related determinants. We compared men and women with RA with non-RA controls from MESA. The distribution of abdominal fat differs significantly by RA status. Higher VFA in men with RA, and the more potent association of VFA with cardiometabolic risk factors in men and women with RA, may contribute to cardiovascular risk in RA populations.
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A practical approach to the metabolic syndrome: review of current concepts and management.
By: Tota-Maharaj R, DeFilippis AP, Blumenthal RS, Blaha MJ.

Recent evidence confirms that diet and exercise continue to be the cornerstone of any metabolic syndrome treatment strategy. The revised “ABCDE” approach incorporates the most recent influential studies into a simple yet thorough algorithm for management of the metabolic syndrome.

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Relation of C-reactive protein to abdominal adiposity
By: Brooks GC, Blaha MJ, Blumenthal RS.
The association between high-sensitivity C-reactive protein (hsCRP) and abdominal adiposity persists when taking into account body mass index. Elevation of hsCRP might be reversible with weight loss and exercise. In conclusion, clinical measurements of abdominal adiposity readily provide data elucidating the systemic inflammatory state of patients and can help guide intensity of lifestyle modifications, thus leading to reduction of this inflammation.
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