High frequency of pre-diabetes, undiagnosed diabetes and metabolic syndrome among overweight Arabs in Israel

Background: Increased insulin resistance, which is associated with obesity, is believed to underlie the development of metabolic syndrome. It is also known to increase the risk for the development of glucose intolerance and type 2 diabetes. Both conditions are recognized as causing a high rate of cardiovascular morbidity and mortality. Objectives: To assess the prevalence of metabolic syndrome and different glucose intolerance states in healthy, overweight Arab individuals attending a primary healthcare clinic in Israel. Methods: We randomly recruited 95 subjects attending a primary healthcare clinic who were healthy, overweight (body mass index > 27) and above the age of 40. Medical and family history was obtained and anthropometric parameters were measured. Blood chemistry and oral glucose tolerance test were performed after overnight fasting. Results: Twenty-seven percent of the subjects tested had undiagnosed type 2 diabetes according to WHO criteria, 42% had impaired fasting glucose and/or impaired glucose tolerance and only 31% had a normal OGTT. Metabolic syndrome was found in 48% according to criteria of the U.S. National Cholesterol Education Program, with direct correlation of this condition with BMI and insulin resistance calculated by homeostasis model assessment. Subjects with metabolic syndrome had a higher risk for abnormality in glucose metabolism, and the more metabolic syndrome components the subject had the higher was the risk for abnormal glucose metabolism. Metabolic syndrome predicted the result of OGTT with 0.67 sensitivity and 0.78 specificity. When combined with IFG, sensitivity was 0.83 and specificity 0.86 for predicting the OGTT result. Conclusions: According to our initial evaluation approximately 70% of the overweight Arab population in Israel has either metabolic syndrome or abnormal glucose metabolism, indicating that they are at high risk to develop type 2 diabetes and cardiovascular morbidity and mortality. This population is likely to benefit from an intervention program.