Diagnosis Of Syndrome X

Since insulin resistance and compensatory hyperinsulinemia are the basic abnormalities leading to the manifestations of syndrome X, it would seem reasonable that these measurements should be central to its diagnosis. However, quantification of insulin resistance is not practical, and there is no gold standard for classifying an individual as hyperinsulinemic, or relating a given insulin concentration to a clinical outcome. Furthermore, use of various formulas based on fasting insulin concentrations or fasting insulin and glucose concentrations to quantify insulin resistance does not provide clinically relevant information. On the other hand, it is relatively simple and quite straightforward to simply determine what, if any, manifestations of syndrome X are present. For this purpose, measurement of: (1) plasma glucose concentrations, fasting and 120 min after a 75-g glucose J

challenge; (2) lipid and lipoprotein concentrations; and (3) blood pressure provide a

Table 2 Diagnosis of Syndrome X

Variable

Unlikely

Likely

Glucose (fasting) Glucose (120 min) Triglyceride HDL cholesterol Men Women Blood pressure

< 45 mg/dL >140/90 mmHg an effective and economical way to search for syndrome X. If all of these values are perfectly normal, it is highly unlikely that the individual is either insulin resistant or hyperinsulinemic. On the other hand, Table 2 presents values that make it quite likely that an abnormality associated with insulin resistance and compensatory hyperinsulinemia exists, and provides the information necessary to initiate rational treatment of syndrome X.

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