Original Article Frequency of the metabolic syndrome in type 2 diabetic subjects attending the dia- betes clinic of a tertiary care hospital Syed Khalid Imam, Syed Khurram Shahid, Asim Hassan, Zakir Alvi Department of Diabetes and Endocrinology, Liaquat National Hospital, Karachi. Abstract Objective: To determine the frequency of the metabolic syndrome in patients with type 2 diabetes mellitus who attended the diabetes clinic of Liaquat National Hospital, Karachi. Method: A descriptive study was conducted at the diabetes clinic of Liaquat National Hospital from June 2004 to December 2004. We enrolled 233 subjects with type 2 diabetes mellitus. Frequency of metabolic syndrome was estimated according to the criteria proposed by National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), with adoption of the Asian criteria for abdominal obesity and recently proposed International Diabetes Federation (IDF) diagnostic criteria for metabolic syn- drome. Results: There were 233 patients with type 2 diabetes mellitus in whom 49.8% were men and 50.2% were women. Mean age was 49.9 years. By applying NCEP-ATP III criteria, metabolic syndrome was found in 79.7% type 2 diabetics, (45.5% women and 34.3% men), by applying IDF criteria, metabolic syndrome was identified in 68.1% of type 2 diabetics (43.7% women and 24.4%. men). Conclusion: In our study the frequency of the metabolic syndrome was found significantly high, especially in women and at a relatively young age of 49.9 years (JPMA 57:239;2007). Introduction The Indo-Pak subcontinent is undergoing epidemiological transition as non-communicable diseases like coronary heart disease and type 2 diabetes mellitus are fast replacing infections as the leading cause of morbidity and mortality. 1 The risks of coronary heart disease and diabetes with metabolic syndrome are greater than those for simple obesity alone, and therefore, an understanding of the pathogenesis, and through it, a rational approach to its therapy are of prime importance. 2 Insulin resistance is the basis of most, if not all of the features of this syndrome. 3 Thus hyperinsulinaemia, glucose intolerance, type 2 dia- betes mellitus, hypertriglyceridaemia, and low HDL cho- lesterol concentrations could be accounted for by resist- ance to the actions of insulin on carbohydrate and lipid metabolism. 2 A proinflammatory state also contributes to the syndrome . 4 Metabolic syndrome is defined as a condition char- acterized by a set of clinical criteria: insulin resistance, obe- sity, hypertension, and atherogenic dyslipidaemia. 5 Gerald Reaven in1988 was the first scientist to name this cluster as syndrome X. 1 In addition to general obesity, the distribution of body fat is independently associated with the metabolic syndrome in older men and women, particu- larly among those of normal body weight. 4 Abdominal sub- cutaneous adipose tissue with expression of inflammatory cytokines is a potential mechanism linking obesity with its metabolic comorbidities. 6 Peroxisome proliferators-activat- ed receptors (PPARs) are ligand-acivated transcription fac- tors that control glucose and lipid metabolism, as well as the inflammatory response. Thus PPARs appear good drug tar- gets for the correction of the global risk profile that predis- poses an individual to the cardiovascular diseases. 7,8 The aim of our study was to determine the frequen- cy of the metabolic syndrome in type 2 diabetic adults so that the magnitude of this rapidly rising and serious global health issue in our setup could be estimated and find out the ways and means to prevent this constellation of syndrome. We believe that the magnitude and seriousness of this prob- lem has largely been underestimated in Pakistan. Subjects and Methods This was a descriptive study conducted at the dia- betes clinic of Liaquat National Hospital, a private tertiary healthcare centre in Karachi, from June 2004 to December 2004. All type 2 diabetics with different ethnic backgrounds of the country were included in the study. Following variables were measured for the metabol- ic syndrome according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP- ATP III) 2001and the new International Diabetes Federation (IDF) guidelines: NCEP-ATP III Guideline 1. Blood glucose fasting >110 mg/dl or known case of type 2 diabetes mellitus. 2. Blood pressure > 130/85-mmHg or known hypertensive. 3. Waist circumference #; man > 90 cm, woman=80 cm (Asian criteria). 9,10 4. Triglyceride > 150 mg/dl. 5. HDL-C; man < 40 mg/dl, woman < 50 mg/dl. Metabolic syndrome is diagnosed when 3 or more criteria are fulfilled. Vol. 57, No. 5, May 2007 239