This study included 184 subjects with T2DM 29% were men with a mean age of 61.5 ± 10.5 years old. Median diabetes time was 10.8 years (IQR 4.8 to 19.4) with a median HbA1c of 8.1% (IQR 6.9 to 9.85), and only 26.8% achieved HbA1c goals. Smoker and sedentary lifestyle prevalences were 18.4% and 73.9%, respectively. Antihypertensive drugs were used by 48.4% for used drugs, statins by 46.7%, and acetylsalicylic acid by 27.7%. Obesity prevalence was 42.3%, with a median waist circumference of 98 cm (IQR 89.7–104). (Table 1)
Tabla 1
Clinical-epidemiological characteristics in subjects with diabetes mellitus without cardiovascular disease at the Edgardo Rebagliati Hospital.
|
Total
N = 184
|
Female
N=131
|
Male
N=53
|
Epidemiological
|
|
|
|
Age, mean (SD)
|
61.5 ± 10.5
|
60.4 ± 10.6
|
64.4 ± 9.9
|
Diabetes time, median (IQR)
|
10.8 (4.8 to 19.4)
|
10.5 (4.7 to 17.7)
|
11.8 (5.5 to 22.2)
|
Smoker, n(%)
|
34 (18.4)
|
18 (13.7)
|
16 (30.2)
|
Sedentary lifestyle, n(%)
|
136 (73.9)
|
31 (23.7)
|
17 (32.1)
|
Drugs
|
|
|
|
Antihipertensive, n(%)
|
89 (48.4)
|
60 (45.8)
|
29 (54.7)
|
Statins, n(%)
|
86 (46.7)
|
61 (45.6)
|
25 (47.2)
|
Acetylsalicilic acid, n(%)
|
50 (27.7)
|
30 (22.9)
|
20 (37.7)
|
Metformin, n(%)
|
166 (90.2)
|
116 (88.6)
|
50 (94.3)
|
Glyburide, n(%)
|
34 (18.5)
|
24 (18.3)
|
10 (18.9)
|
SGLT2 inhibitor, n(%)
|
1 (0.5)
|
0 (0.0)
|
1 (1.9)
|
GLP1 agonist, n(%)
|
1 (0.5)
|
1 (0.0)
|
0 (0.0)
|
Insulin, n(%)
|
69 (37.5)
|
50 (38.2)
|
19 (35.9)
|
Clinical
|
|
|
|
Body mass index (kg/m2), median (IQR)
|
28.8 (25.7 to 32.2)
|
28.9 (25.8 to 32.2)
|
28.6 (25.2 to 32.4)
|
BMI >30 kg/m2, n(%)
|
72 (42.3)
|
51 (42.9)
|
21 (41.2)
|
Waist circumference (cm), median (IQR)
|
98 (89.75 to 104)
|
100 (91 to 105)
|
97 (88 to 104)
|
Blood pressure >130/85, n(%)
|
83 (45.1)
|
63 (48.1)
|
20 (37.7)
|
Glycemia (mg/dl), median (IQR)
|
135 (106 to 193)
|
143 (106 to 213)
|
131 (106 to 153)
|
Triglycerides, median (IQR)
|
163 (107.5 to 224)
|
170 (118 to 244)
|
138 (101 to 196)
|
Total Cholesterol (mg/dl)
|
178.5 (151 to 212)
|
189 (161 to 215)
|
158 (133 to 195)
|
HDL cholesterol (mg/dl), median (IQR)
|
45 (39 to 52)
|
48 (41 to 54)
|
40 (34 to 48)
|
LDL cholesterol (mg/dl), median (IQR)
|
110 (89 to 139)
|
116.5 (94 to 142)
|
101 (75 to 123)
|
Glomerular filtration (ml/min/24 h), median (IQR)
|
105.3 (87.6 to 116.7)
|
108.3 (96 to 117)
|
94 (85 to 106)
|
A1C (%), median (IQR)
|
8.1 (6.9 to 9.85)
|
8.2 (6.9 to 10.1)
|
8 (6.85 to 9.4)
|
A1c < 7%
|
48 (26.7)
|
34 (26.6)
|
14 (26.9)
|
Metabolic syndrome
|
|
|
|
ATP III criteria, n(%)
|
135 (73.4)
|
86 (65.7)
|
49 (92.5)
|
Harmonizing criteria, n(%)
|
145 (78.8)
|
96 (73.3)
|
49 (92.5)
|
MSSS
|
|
|
|
Z- score MSSS, median (IQR)
|
1.34 (0.58 to 2.71)
|
1.78 (0.70 to 3.28)
|
0.84 (0.46 to 1.48)
|
Z-score MSSS ≥ 0 , n(%)
|
110 (59.8)
|
119 (90.8)
|
47 (88.7)
|
Z-score non-glucose MSSS, median (IQR)
|
-1.08 (-1.54 to -0.54)
|
-1.30 (-1.66 to -0.89)
|
-0.43 (-0.91 to -0.19)
|
Z-score non-glucose MSSS ≥ 0 , n(%)
|
8 (4.3)
|
1 (0.7)
|
7 (13.2)
|
CIMT
|
|
|
|
(mm), Median (IQR)
|
0.8 (0.7 to 0.9)
|
0.75 (0.7 to 0.85)
|
0.85 (0.7 to 0.95)
|
≥ 0.86 mm, n(%)
|
54 (29.4)
|
32 (24.4)
|
22 (41.5)
|
IQR Interquartile range, SD Standard deviation, HDL high-density lipoprotein, LDL low-density lipoprotein, SGLT2 Sodium-glucose cotransporter -2; GLP1 glucagon-like peptide-1; ATP III: Adult treatment Panel III. CIMT: carotid medial intima thickness
|
Metabolic syndrome for ATP III criteria and Harmonized criteria were 73.4% and 78.8%, respectively. The Median Z-score of the MSSS was 1.34 (IQR 0.58 to 2.71), and the median Z-score of the non-glucose MSSS was − 1.08 (IQR − 1.54 to -0.54). The prevalence of MSSS and non-glucose MSSS above Z-score ≥ 0 were 59.8% and 4.3%, respectively. (Table 1 )
Median CIMT was 0.8 mm (0.7–0.9), and the prevalence of elevated CIMT, defined by Rizzo (≥ 0.86 mm), was 29.4%. CIMT tends to increase according to age in both sexes (Fig. 1)
Only non-glucose MSSS showed a correlation with CIMT. (r = 0.19, p < 0.01). (Fig. 2). Non-glucose MSSS obtained the best AUROC 0.61 (0.52–0.70) compared with the other definitions. (Fig. 3). MSSS and Harmonized SM criteria included 0.5 in their confidence interval. A Z-score of -1.0 was the best cut-of point of non-glucose MSSS to predict elevated CIMT. This value had 57.4% and 60% of sensitivity and specificity, respectively. (Table 2)
Table 2
The area under the ROC of the Metabolic Syndrome Severity Score and Classic Definitions of Metabolic Syndrome for carotid medial intima thickness in Subjects with Diabetes Mellitus without Cardiovascular Disease at the Edgardo Rebagliati Martins Hospital.
|
AUC ROC
|
Optimal cut-off
|
Sensitivity
|
Specificity
|
Metabolic síndrome
|
|
|
|
|
ATPIII MS criterio
|
0.59 (0.51 to 0.68)
|
4
|
44.4%
|
71.5%
|
Harmonizing MS criteria
|
0.56 (0.47 to 0.65)
|
4
|
53.7%
|
59.2%
|
Metabolic Syndrome Severity Score
|
|
|
|
|
MSSS
|
0.48 (0.39 to 0.57)
|
0.30
|
87.0%
|
20%
|
Non-glucose MSSS
|
0.61 (0.52 to 0.70)
|
-1.00
|
57.4%
|
60%
|
MS ATP III: 3 of 5 criteria according to Adult Treatment Panel III. MS Harmonizing criteria: : 3 of 5 criteria according to Harmonized Consensus. |
Only systolic pressure was associated with CIMT (PR 1.01 CI95% 1.01 to 1.03; p < 0.000) of the metabolic syndrome factors. Age, male sex, and the use of hypertensive drugs also showed association with CIMT (Table 3).
Table 3
The prevalence rate of factors associated with elevated carotid medial intima thickness in subjects with diabetes mellitus without cardiovascular disease at the Edgardo Rebagliati Martins Hospital.
|
PR
|
CI 95%
|
P
|
Metabolic Syndrome factors
|
|
|
|
Glycemia (mg/dl)
|
0.99
|
0.99–1.00
|
0.52
|
Waist circunference (cm)
|
1.00
|
0.98–1.02
|
0.56
|
HDL colesterol (mg/dl)
|
0.98
|
0.96–1.01
|
0.12
|
Triglycerides (mg/dl)
|
1.00
|
0.99–1.00
|
0.33
|
Systolic blood pressure (mmHg)
|
1.01
|
1.01–1.03
|
0.000
|
Other factors
|
|
|
|
Age (years old)
|
1.06
|
1.03–1.09
|
0.000
|
Male sex
|
1.69
|
1.09–2.63
|
0.018
|
Smoker
|
1.12
|
0.65–1.95
|
0.66
|
Diabetes time (years)
|
1.01
|
0.99–1.03
|
0.12
|
Body mass Index (kg/m2)
|
0.99
|
0.95–1.05
|
0.99
|
A1c (%)
|
0.95
|
0.86–1.06
|
0.41
|
Total cholesterol (mg/dl)
|
1.00
|
0.99–1.01
|
0.95
|
LDL cholesterol
|
0.99
|
0.99–1.00
|
0.86
|
Hypertension drug
|
2.13
|
1.31–3.47
|
0.002
|
Statins drug
|
0.72
|
0.45–1.15
|
0.17
|
PR: Prevalence rate. CI95% Confidence Interval 95. |
aUnivariate regression using generalized linear model with robust variance and poisson distribution. A value of 0.86 mm is considered as anormal carotide medial intima thickness. |
In the crude analysis, each point increase in the non-glucose MSSS Z score, the risk of altered CIMT increases by 55% PR 1.55 (CI95% 1.05 to 2.28). Adjusting for age, sex, and HbA1c, MSSS also showed association PR 1.59 (CI 95% 1.09 to 2.35; p = 0.017). (Table 4)
Table 4
Multivariate analysis of the severity score of metabolic syndrome without glycemia for the thickness of the medial carotid intima-media in subjects with diabetes mellitus without cardiovascular disease at Hospital Edgardo Rebagliati.
|
Bivariate
|
|
Multivariate model 1a
|
|
Multivariate model 2b
|
|
|
PR
|
Ci 95%
|
P
|
PR
|
Ci 95%
|
p
|
PR
|
Ci 95%
|
P
|
Non-glucose MSSS (Z score)
|
1.55
|
1.05–2.28
|
0.01
|
1.54
|
1.07–2.22
|
0.02
|
1.59
|
1.09–2.35
|
0.017
|
Age (years old)
|
1.06
|
1.03–1.09
|
0.000
|
1.06
|
1.04–1.09
|
0.000
|
1.06
|
1.04–1.09
|
0.000
|
Male
|
1.69
|
1.09–2.63
|
0.018
|
0.95
|
0.57–1.57
|
0.84
|
0.91
|
0.55–1.50
|
0.71
|
A1c (%)
|
0.95
|
0.86–1.06
|
0.41
|
|
|
|
0.96
|
0.86–1.07
|
0.53
|
PR: Prevalence rate. CI95% Confidence Interval 95%. MSSS: Metabolic síndrome severity score. |
aMultivariate regression using a generalized linear model with robust variance and Poisson distribution. A value of 0.86 mm is considered as abnormal carotid medial intima thickness. |
aModel 1: Adjusted to age and sex. bModel 2: Adjusted to age, sex, and A1c. |