Evidence:

• Forty-eight percent to 67% of persons with previously undiagnosed diabetes have hypertension (21; 22). In a study of 12,550 U.S. adults aged 45 to 64, the incidence of diabetes in persons with hypertension was found to be over two times that of persons without hypertension (RR, 2.43 [CI, 2.16 to 2.73], absolute risk 29.1 vs. 12.0/1000 person-years) (23).
• Seventy-three percent of adults with diabetes have BP >130/80 mm Hg or are on treatment for hypertension (8).
• Sixty-two percent of persons with undiagnosed diabetes have LDL cholesterol concentrations of >130 mg/dL and 24% to 72% have high triglycerides (24; 21; 22). Hypertriglyceridemia is associated with an odds ratio of 2.29 for diabetes (24).
• Improved control of lipids can reduce CVD complications by 20% to 50% (8).
• For every 10-mm Hg reduction in systolic BP, the risk for any diabetes complication is reduced by 12% (8).
• Based on NHANES III data, U.S. adults aged 50 or older who meet the NCEP criteria for the metabolic syndrome are over eight times as likely to have diabetes as those without the metabolic syndrome (24).
• The features of the metabolic syndrome can be used to identify the risk of diabetes, but the predictive usefulness is due mainly to fasting plasma glucose. Among 1155 adults, the AROC was 0.76 for prediabetes, which was similar to that for random plasma glucose (0.72). Overall, to identify diabetes or prediabetes in blacks and whites with varying ages and BMIs, metabolic syndrome features are no better than random plasma glucose (25).

Comments:

• Criteria for the metabolic syndrome are at least three of the following: a waist circumference >40.2 in/102 cm in males or >34.6 in/88 cm in females; serum triglycerides 150 mg/dL; HDL cholesterol <40 mg/dL in males or <50 mg/dL in females; BP 130/85; and fasting glucose >110 mg/dL (6.1 mmol/L) (26).