& u higher in the women than in the normal population. Their data indicated that the insulin resistance syndrome preceded the development of type 2 diabetes by many years and that impaired glucose tolerance was associated with the insulin resistance syndrome. Recently, they have further analyzed their prediabetic cohort by defining insulin resistance at baseline by the HOMA model and insulin secretion by the incremental increase in plasma insulin 30 min after an oral glucose load divided by the incremental increase in plasma glucose. Of 195 individuals who developed diabetes, 161 were insulin resistant at baseline and 34 were insulin sensitive. The components of the insulin resistance syndrome were present only in those with insulin resistance as determined by HOMA (36).

Insulin resistance occurs very commonly in societies that have acquired western cultural patterns. In Europe, it is estimated that 16% of the adult population has the insulin resistance syndrome. In a recent analysis of the Botnia population in Finland, the prevalence of the metabolic syndrome as defined by WHO was assessed in individuals with normal glucose tolerance, impaired glucose tolerance, or impaired fasting plasma glucose (IFG), and type 2 diabetes (37). The WHO definition of the metabolic syndrome is (1) hypertension (BP >160/90 mmHg or treatment for hypertension); (2) dyslipidemia, defined as plasma triglyceride >1.7 mmol/L (150 mg/dL) and/or HDL cholesterol <0.9 mmol/L (35 mg/dL) in men or <1.0 mmol/L (38.5 mg/dL) in women; (3) obesity, defined as BMI >30 kg/m2 and/or WHR >0.90 in men or >0.85 in women; and (4) microalbuminuria (urinary albumin excretion >20 |J.g/min). Fifteen (10%) of normal glucose-tolerant men and women aged 35 to 70 years had the metabolic syndrome as compared to 64 (42%) of those with IFG/IGT and 84 (78%) of those with type 2 diabetes.

A routine health examination of 2113 middle-aged men and women in Tokyo in the early 1990s revealed the following prevalence of components of the insulin resistance syndrome: obesity 20.9%; hypertension 23.1%; hyperinsuli-nemia 11.0%; hypertriglyceridemia 24.4%; low HDL cholesterol 23.0% (38). The individuals with hyperinsulinemia had higher plasma triglycerides, lower plasma HDL cholesterol, higher systolic and diastolic blood pressure, and higher area-under-the-plasma glucose curve during the oral glucose tolerance than those with normoinsulinemia matched for age, sex, and BMI. Individuals with glucose intolerance (defined as 2-h plasma glucose >133 mg/dL after a 100-g oral glucose load) had higher plasma triglycerides, higher systolic and diastolic blood pressures, and higher area-under-the-2-h plasma glucose curve during the OGTT as compared to the normal glucose-tolerant individuals matched for age, sex, and BMI.

As noted previously, fasting plasma glucose as well as post-glucose-challenge plasma glucose predicts the future development of type 2 diabetes. This was the reason for the definition of the new category of glucose intolerance called

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