Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance

Diabetes Obes Metab. 2014 Apr;16(4):326-33. doi: 10.1111/dom.12220. Epub 2013 Oct 29.


Aims: To determine the association of metabolic syndrome (MetS) and its components with diabetes risk in participants with impaired glucose tolerance (IGT), and whether intervention-related changes in MetS lead to differences in diabetes incidence.

Methods: We used the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) revised MetS definition at baseline and intervention-related changes of its components to predict incident diabetes using Cox models in 3234 Diabetes Prevention Program (DPP) participants with IGT over an average follow-up of 3.2 years.

Results: In an intention-to-treat analysis, the demographic-adjusted hazard ratios (95% confidence interval) for diabetes in those with MetS (vs. no MetS) at baseline were 1.7 (1.3-2.3), 1.7 (1.2-2.3) and 2.0 (1.3-3.0) for placebo, metformin and lifestyle groups, respectively. Higher levels of fasting plasma glucose and triglycerides at baseline were independently associated with increased risk of diabetes. Greater waist circumference (WC) was associated with higher risk in placebo and lifestyle groups, but not in the metformin group. In a multivariate model, favourable changes in WC (placebo and lifestyle) and high-density lipoprotein cholesterol (placebo and metformin) contributed to reduced diabetes risk.

Conclusions: MetS and some of its components are associated with increased diabetes incidence in persons with IGT in a manner that differed according to DPP intervention. After hyperglycaemia, the most predictive factors for diabetes were baseline hypertriglyceridaemia and both baseline and lifestyle-associated changes in WC. Targeting these cardiometabolic risk factors may help to assess the benefits of interventions that reduce diabetes incidence.

Keywords: cardiometabolic risk; diabetes prevention; lifestyle; metformin.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Blood Glucose / metabolism*
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / prevention & control*
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / etiology
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Diabetic Angiopathies / blood
  • Diabetic Angiopathies / epidemiology
  • Diabetic Angiopathies / prevention & control*
  • Diet, Reducing
  • Exercise
  • Fasting
  • Female
  • Glucose Intolerance / complications*
  • Glucose Intolerance / drug therapy
  • Glucose Intolerance / therapy*
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Incidence
  • Male
  • Metabolic Syndrome / blood
  • Metabolic Syndrome / epidemiology
  • Metabolic Syndrome / etiology
  • Metabolic Syndrome / prevention & control*
  • Metformin / therapeutic use*
  • Middle Aged
  • Proportional Hazards Models
  • Remission Induction
  • Risk Factors
  • Risk Reduction Behavior*
  • Triglycerides / blood*
  • Waist Circumference


  • Blood Glucose
  • Hypoglycemic Agents
  • Triglycerides
  • Metformin