Obesity Research & Clinical Practice (2010) 4, e293—e299
ORIGINAL ARTICLE
Characteristics of metabolic syndrome and its clinical components among diabetic Vietnamese patients: A survry at two institutions in Ho Chi Minh City夽 Hirohide Yokokawa a,b,∗, Aya Goto b, Nguyen Thy Khue c, Tran Quang Nam c, Tran The Trung c, Vo Tuan Khoa d, Nguyen Thi Boi Ngoc d, Pham Nghiem Minh e, Nguyen Quang Vinh f, Akira Okayama g, Seiji Yasumura b a
Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan c Department of Endocrinology, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam d Department of Endocrinology, People’s Hospital 115, Ho Chi Minh City, Viet Nam e Anapathology-Cytology-Genetics Department, Tu Du Obstetrical and Gynecological Hospital, Ho Chi Minh City, Viet Nam f Hanh Phuc Women and Children Hospital Project, Thuan An, Binh Duong, Ho Chi Minh City, Viet Nam g The First Institute for Health Promotion and Health Care, Japan Anti-Tuberculosis Association, Tokyo, Japan b
Received 18 June 2010 ; received in revised form 25 August 2010; accepted 31 August 2010
KEYWORDS Metabolic syndrome; Diabetes mellitus; Disease management; Chronic disease; Primary care
Summary Objective: The purpose of this study was to estimate the prevalence of metabolic syndrome among Vietnamese diabetic patients and to investigate their characteristics. Methods: This cross-sectional study was conducted among 652 outpatients who were recruited from one public general hospital (People Hospital 115) and one private clinic (Medic Center) in Ho Chi Minh City, Vietnam. We obtained informed consent from participants, collected clinical information from medical files, and conducted patient interviews. We evaluated the collected information descriptively and diagnosed metabolic syndrome according to the International Diabetes Federation (IDF) Worldwide Definition of the Metabolic Syndrome.
夽
This study was funded by a grant from the Health Promotion Foundation, 2-8-22, Azusawa, Itabashi, Tokyo, 174-0051, Japan. Corresponding author at: Department of General Medicine, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan. Tel.: +81 3 3813 3111; fax: +81 3 5802 1190. E-mail address: [email protected] (H. Yokokawa). ∗
1871-403X/$ — see front matter © 2010 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.orcp.2010.08.006
e294
H. Yokokawa et al. Results: A total of 517 eligible patients (175 men and 342 women) were analyzed. Mean age was 54.6 years for men and 60.7 years for women. Metabolic syndrome was observed in 39.4% of men and 70.5% of women. Central obesity was more prevalent among women (72.5%) compared to men (39.4%). Participants with metabolic syndrome were less likely to endorse a sense of general well-being, and women with metabolic syndrome were likely to have less diabetes-related distress. Conclusions: this study revealed a high prevalence of metabolic syndrome in diabetic Vietnamese patients, especially among women, and revealed central obesity as a key feature. A prospective study should be conducted in this population in order to assess impacts of metabolic syndrome on disease outcome. © 2010 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
Introduction The prevalence of diabetes mellitus has increased significantly in recent years in Southeast Asia, and this region is predicted to outstrip Europe in 2025 as the area with the highest number of diabetic patients [1]. In the Socialist Republic of Vietnam, prevalence of diabetes has similarly increased, from 2.5% in 1993 to 6.9% in 2001 in Ho Chi Minh City [2]. Primary and secondary prevention of this disease is a serious issue for the country as a whole. In recent years, metabolic syndrome has received considerable attention as an important risk factor for development of atherosclerotic cardiovascular disorders [3,4]. The syndrome is defined as a cluster of abnormalities including central obesity, hyperglycemia, hypertension, and dyslipidemia. Its prevalence was estimated at 30—40% among adults in the United States [5], and 26.9% in men and 9.9% in women among Japanese aged 40 years and above [6]. Although there is as yet no nation-wide survey of Vietnamese to estimate the prevalence of metabolic syndrome, a crosssectional survey in the urban population of Ho Chi Minh City revealed a prevalence of about 12% [7]. A high prevalence of metabolic syndrome is reported among diabetic patients in Asia as well as Europe [8—12]. The prevalence is much higher than one would expect considering that elevated blood glucose concentration is not a requested criteria, but just one of the diagnostic criteria of metabolic syndrome. A cross-sectional study conducted in Pakistan reported that among type 2 diabetics, 95.3% of females and 71.4% of males had metabolic syndrome [8]. In addition, a prospective cohort study in Hong Kong showed that 65.9% of subjects with type 2 diabetes mellitus had metabolic syndrome according to the criteria of either the International Diabetes Federation (IDF) or The Third Report of The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In
Adults (NCEP Adult Treatment Panel III) [10]. Data from the United States [12] was 86%, compared to that from Italy [13], which was 75.6%. The high prevalence of metabolic syndrome among patients with diabetes is alarming, given its reported negative impacts. A cross-sectional study in the United States reported that the proportion of patients with diabetes who had histories of coronary heart disease (CHD) was 7.5% among individuals without metabolic syndrome. In contrast, the proportion was 19.2% in those with metabolic syndrome [11]. Similarly, the San Antonio Heart Study [12], a prospective study conducted in the United States, reported that among patients with diabetes, those with metabolic syndrome have a significantly higher risk for CVD mortality, regardless of sex. Although a few epidemiologic surveys have reported on the prevalence of metabolic syndrome within the general Vietnamese population, related available information among diabetic patients is limited to domestic reports. We conducted an epidemiologic survey in Ho Chi Minh City to investigate characteristics of Vietnamese outpatients with diabetes, factors associated with diabetic control, and their capacity to self-manage the disease [14]. The present study used secondary data from the previously constructed database and focused on characteristics of metabolic syndrome in these patients, and we aimed (a) to estimate the prevalence of metabolic syndrome among diabetic Vietnamese patients and (b) to investigate the clinical characteristics of diabetes mellitus and metabolic syndrome.
Methods This cross-sectional study was conducted from December 17, 2007 to January 17, 2008 in Ho Chi Minh City, Vietnam; a detailed description of the study protocol is provided in our previous report [14]. Study participants were diabetic outpatients
Characteristics of metabolic syndrome who visited endocrinologists at either a polyclinic (Medic Center) or a public hospital (People Hospital 115) and were examined by four Vietnamese co-investigators. General medical history data included the following items: date of birth, sex, anthropometrics, family history, and health behaviors including tobacco smoking and alcohol consumption. Data specifically related to diabetes mellitus included the following: year of diagnosis, year medication was initiated, type of diabetes, and glycemic measurements from the past six months including fasting or casual blood glucose concentration (mg/dl) and hemoglobin A1c level (%). Information regarding hypertension included measurements of systolic and diastolic blood pressure (BP) (mm Hg) and medication for hypertension. Lipid profiles included data from the previous six months on total cholesterol (TC) (mg/dl), high-density lipoprotein cholesterol (HDL-C) (mg/dl), lowdensity lipoprotein cholesterol (LDL-C) (mg/dl), triglycerides (TG) (mg/dl), and medication for hyperlipidemia. LDL-C was estimated using the Friedewald equation (LDL-C = TC − HDL-C − TG/5) [15]. Participants were asked about their sense of well-being [16], diabetes-related distress [17], evaluation of self-management [17], and perception of diabetic control [17]. The well-being measurement was composed of five statements: ‘‘I have felt cheerful and in good spirits,’’ ‘‘I have felt calm and relaxed,’’ ‘‘I have felt active and vigorous,’’ ‘‘I woke up feeling fresh and rested,’’ and ‘‘My daily life has been filled with things that interest me.’’ Participants were asked to evaluate each statement on a scale of 0—5 (0 = at no time, 5 = all of the time). Total scores were calculated and fit to a scale ranging from 0 to 100. Perception of diabetic control was assessed by asking patients to evaluate the statement ‘‘To what extent do you feel you control your diabetes?’’ on a scale of 1—4 (1 = not at all, 4 = to a great extent). Distress related to diabetes was assessed by evaluation of four statements: ‘‘I feel stressed because of my diabetes,’’ ‘‘I am constantly afraid of my diabetes getting worse,’’ ‘‘Coping with diabetes is more difficult than it used to be,’’ and ‘‘I feel burned out from having to cope with diabetes.’’ Participants were asked to evaluate each statement on a scale of 1—4 (1 = fully disagree, 4 = fully agree). Evaluation of self-management was assessed with a five-part question: ‘‘How successful have you been in following: (1) diet, (2) exercise, (3) medication, (4) appointment keeping, and (5) self-monitoring blood glucose (if instructed), recommendations given by your doctor or nurse for managing your diabetes?’’
e295 Participants were asked to answer the questions on a scale of 1—4 (1 = never, 4 = completely). We evaluated the collected information descriptively and diagnosed metabolic syndrome according to the IDF Worldwide Definition of the Metabolic Syndrome [3]. These criteria define metabolic syndrome as central obesity (male waist circumference ≥90 cm, female waist circumference ≥80 cm) plus any one of the following three factors: (1) elevated TG level (≥150 mg/dl) or specific treatment for elevated TG, (2) reduced HDL-C level (
ORIGINAL ARTICLE
Characteristics of metabolic syndrome and its clinical components among diabetic Vietnamese patients: A survry at two institutions in Ho Chi Minh City夽 Hirohide Yokokawa a,b,∗, Aya Goto b, Nguyen Thy Khue c, Tran Quang Nam c, Tran The Trung c, Vo Tuan Khoa d, Nguyen Thi Boi Ngoc d, Pham Nghiem Minh e, Nguyen Quang Vinh f, Akira Okayama g, Seiji Yasumura b a
Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan c Department of Endocrinology, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam d Department of Endocrinology, People’s Hospital 115, Ho Chi Minh City, Viet Nam e Anapathology-Cytology-Genetics Department, Tu Du Obstetrical and Gynecological Hospital, Ho Chi Minh City, Viet Nam f Hanh Phuc Women and Children Hospital Project, Thuan An, Binh Duong, Ho Chi Minh City, Viet Nam g The First Institute for Health Promotion and Health Care, Japan Anti-Tuberculosis Association, Tokyo, Japan b
Received 18 June 2010 ; received in revised form 25 August 2010; accepted 31 August 2010
KEYWORDS Metabolic syndrome; Diabetes mellitus; Disease management; Chronic disease; Primary care
Summary Objective: The purpose of this study was to estimate the prevalence of metabolic syndrome among Vietnamese diabetic patients and to investigate their characteristics. Methods: This cross-sectional study was conducted among 652 outpatients who were recruited from one public general hospital (People Hospital 115) and one private clinic (Medic Center) in Ho Chi Minh City, Vietnam. We obtained informed consent from participants, collected clinical information from medical files, and conducted patient interviews. We evaluated the collected information descriptively and diagnosed metabolic syndrome according to the International Diabetes Federation (IDF) Worldwide Definition of the Metabolic Syndrome.
夽
This study was funded by a grant from the Health Promotion Foundation, 2-8-22, Azusawa, Itabashi, Tokyo, 174-0051, Japan. Corresponding author at: Department of General Medicine, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan. Tel.: +81 3 3813 3111; fax: +81 3 5802 1190. E-mail address: [email protected] (H. Yokokawa). ∗
1871-403X/$ — see front matter © 2010 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.orcp.2010.08.006
e294
H. Yokokawa et al. Results: A total of 517 eligible patients (175 men and 342 women) were analyzed. Mean age was 54.6 years for men and 60.7 years for women. Metabolic syndrome was observed in 39.4% of men and 70.5% of women. Central obesity was more prevalent among women (72.5%) compared to men (39.4%). Participants with metabolic syndrome were less likely to endorse a sense of general well-being, and women with metabolic syndrome were likely to have less diabetes-related distress. Conclusions: this study revealed a high prevalence of metabolic syndrome in diabetic Vietnamese patients, especially among women, and revealed central obesity as a key feature. A prospective study should be conducted in this population in order to assess impacts of metabolic syndrome on disease outcome. © 2010 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
Introduction The prevalence of diabetes mellitus has increased significantly in recent years in Southeast Asia, and this region is predicted to outstrip Europe in 2025 as the area with the highest number of diabetic patients [1]. In the Socialist Republic of Vietnam, prevalence of diabetes has similarly increased, from 2.5% in 1993 to 6.9% in 2001 in Ho Chi Minh City [2]. Primary and secondary prevention of this disease is a serious issue for the country as a whole. In recent years, metabolic syndrome has received considerable attention as an important risk factor for development of atherosclerotic cardiovascular disorders [3,4]. The syndrome is defined as a cluster of abnormalities including central obesity, hyperglycemia, hypertension, and dyslipidemia. Its prevalence was estimated at 30—40% among adults in the United States [5], and 26.9% in men and 9.9% in women among Japanese aged 40 years and above [6]. Although there is as yet no nation-wide survey of Vietnamese to estimate the prevalence of metabolic syndrome, a crosssectional survey in the urban population of Ho Chi Minh City revealed a prevalence of about 12% [7]. A high prevalence of metabolic syndrome is reported among diabetic patients in Asia as well as Europe [8—12]. The prevalence is much higher than one would expect considering that elevated blood glucose concentration is not a requested criteria, but just one of the diagnostic criteria of metabolic syndrome. A cross-sectional study conducted in Pakistan reported that among type 2 diabetics, 95.3% of females and 71.4% of males had metabolic syndrome [8]. In addition, a prospective cohort study in Hong Kong showed that 65.9% of subjects with type 2 diabetes mellitus had metabolic syndrome according to the criteria of either the International Diabetes Federation (IDF) or The Third Report of The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In
Adults (NCEP Adult Treatment Panel III) [10]. Data from the United States [12] was 86%, compared to that from Italy [13], which was 75.6%. The high prevalence of metabolic syndrome among patients with diabetes is alarming, given its reported negative impacts. A cross-sectional study in the United States reported that the proportion of patients with diabetes who had histories of coronary heart disease (CHD) was 7.5% among individuals without metabolic syndrome. In contrast, the proportion was 19.2% in those with metabolic syndrome [11]. Similarly, the San Antonio Heart Study [12], a prospective study conducted in the United States, reported that among patients with diabetes, those with metabolic syndrome have a significantly higher risk for CVD mortality, regardless of sex. Although a few epidemiologic surveys have reported on the prevalence of metabolic syndrome within the general Vietnamese population, related available information among diabetic patients is limited to domestic reports. We conducted an epidemiologic survey in Ho Chi Minh City to investigate characteristics of Vietnamese outpatients with diabetes, factors associated with diabetic control, and their capacity to self-manage the disease [14]. The present study used secondary data from the previously constructed database and focused on characteristics of metabolic syndrome in these patients, and we aimed (a) to estimate the prevalence of metabolic syndrome among diabetic Vietnamese patients and (b) to investigate the clinical characteristics of diabetes mellitus and metabolic syndrome.
Methods This cross-sectional study was conducted from December 17, 2007 to January 17, 2008 in Ho Chi Minh City, Vietnam; a detailed description of the study protocol is provided in our previous report [14]. Study participants were diabetic outpatients
Characteristics of metabolic syndrome who visited endocrinologists at either a polyclinic (Medic Center) or a public hospital (People Hospital 115) and were examined by four Vietnamese co-investigators. General medical history data included the following items: date of birth, sex, anthropometrics, family history, and health behaviors including tobacco smoking and alcohol consumption. Data specifically related to diabetes mellitus included the following: year of diagnosis, year medication was initiated, type of diabetes, and glycemic measurements from the past six months including fasting or casual blood glucose concentration (mg/dl) and hemoglobin A1c level (%). Information regarding hypertension included measurements of systolic and diastolic blood pressure (BP) (mm Hg) and medication for hypertension. Lipid profiles included data from the previous six months on total cholesterol (TC) (mg/dl), high-density lipoprotein cholesterol (HDL-C) (mg/dl), lowdensity lipoprotein cholesterol (LDL-C) (mg/dl), triglycerides (TG) (mg/dl), and medication for hyperlipidemia. LDL-C was estimated using the Friedewald equation (LDL-C = TC − HDL-C − TG/5) [15]. Participants were asked about their sense of well-being [16], diabetes-related distress [17], evaluation of self-management [17], and perception of diabetic control [17]. The well-being measurement was composed of five statements: ‘‘I have felt cheerful and in good spirits,’’ ‘‘I have felt calm and relaxed,’’ ‘‘I have felt active and vigorous,’’ ‘‘I woke up feeling fresh and rested,’’ and ‘‘My daily life has been filled with things that interest me.’’ Participants were asked to evaluate each statement on a scale of 0—5 (0 = at no time, 5 = all of the time). Total scores were calculated and fit to a scale ranging from 0 to 100. Perception of diabetic control was assessed by asking patients to evaluate the statement ‘‘To what extent do you feel you control your diabetes?’’ on a scale of 1—4 (1 = not at all, 4 = to a great extent). Distress related to diabetes was assessed by evaluation of four statements: ‘‘I feel stressed because of my diabetes,’’ ‘‘I am constantly afraid of my diabetes getting worse,’’ ‘‘Coping with diabetes is more difficult than it used to be,’’ and ‘‘I feel burned out from having to cope with diabetes.’’ Participants were asked to evaluate each statement on a scale of 1—4 (1 = fully disagree, 4 = fully agree). Evaluation of self-management was assessed with a five-part question: ‘‘How successful have you been in following: (1) diet, (2) exercise, (3) medication, (4) appointment keeping, and (5) self-monitoring blood glucose (if instructed), recommendations given by your doctor or nurse for managing your diabetes?’’
e295 Participants were asked to answer the questions on a scale of 1—4 (1 = never, 4 = completely). We evaluated the collected information descriptively and diagnosed metabolic syndrome according to the IDF Worldwide Definition of the Metabolic Syndrome [3]. These criteria define metabolic syndrome as central obesity (male waist circumference ≥90 cm, female waist circumference ≥80 cm) plus any one of the following three factors: (1) elevated TG level (≥150 mg/dl) or specific treatment for elevated TG, (2) reduced HDL-C level (
