Navigating Metabolic Complexity and in-Depth Analysis of Metabolic Syndrome among Diabetes Mellitus Patients: A Systematic Review and Meta-Analysis
Abstract
Background: This systematic review and meta-analysis aimed to evaluate the prevalence and clinical implications of metabolic syndrome in individuals with diabetes mellitus.
Methods: A comprehensive search was conducted across multiple databases using key terms related to metabolic syndrome and diabetes. Access to subscription-based journals was facilitated through the HINARI program. Study quality was assessed using the adapted Newcastle–Ottawa scale, with a minimum inclusion score of ≥5/10. Statistical analysis included a meta-analysis using the DerSimonian and Laird random-effects model to determine the pooled prevalence, with heterogeneity assessed using Cochran’s Q and I² statistics. Publication bias was evaluated via funnel plot symmetry. Analyses were conducted using Stata/MP 17.0.
Results: The meta-analysis revealed a pooled effect size of 1.98 (95% CI: 1.85, 2.10), with significant heterogeneity (I² = 92.35%). Prevalence ranged from 19.88% to 88.13%, underscoring a substantial burden. Variations in HbA1c, HDL cholesterol, blood pressure, and BMI highlighted the heterogeneity in metabolic syndrome characteristics. Advanced statistical approaches enriched the understanding of metabolic profiles and their interplay with glycemic control and lipid metabolism.
Conclusion: This study underscores the critical interplay between glycemic control and lipid profiles in metabolic syndrome. The findings emphasize the need for tailored, region-specific interventions to address its substantial burden and implications for clinical practice and policy.
1. Huang PL (2009). A comprehensive defini-tion for metabolic syndrome. Dis Model Mech, 2(5-6): 231-37.
2. Shin JA, Lee JH, Lim SY, et al (2013). Meta-bolic syndrome as a predictor of type 2 diabetes, and its clinical interpretations and usefulness. J Diabetes Investig, 4(4): 334-43.
3. Kassi E, Pervanidou P, Kaltsas G, et al (2011). Metabolic syndrome: definitions and controversies. BMC Med, 9: 48.
4. Saklayen MG (2018). The Global Epidemic of the Metabolic Syndrome. Curr Hyper-tens Rep, 20(2): 12.
5. Vrablik M, Dlouha D, Todorovova V, et al (2021). Genetics of Cardiovascular Dis-ease: How Far Are We from Personal-ized CVD Risk Prediction and Man-agement? Int J Mol Sci, 22(8): 4182.
6. Moudatsou M, Stavropoulou A, Philalithis A, et al (2020). The Role of Empathy in Health and Social Care Professionals. Healthcare (Basel), 8(1): 26.
7. Guidi C, Traversa C (2021). Empathy in pa-tient care: from 'Clinical Empathy' to 'Empathic Concern'. Med Health Care Philos, 24(4): 573-85.
8. Khan MAB, Hashim MJ, King JK, et al (2020). Epidemiology of Type 2 Diabe-tes - Global Burden of Disease and Forecasted Trends. J Epidemiol Glob Health, 10(1): 107-11.
9. Adnan M, Aasim M (2020). Prevalence of Type 2 Diabetes Mellitus in Adult Popu-lation of Pakistan: A Meta-Analysis of Prospective Cross-Sectional Surveys. Ann Glob Health, 86(1): 7.
10. Harding JL, Pavkov ME, Magliano DJ, et al (2019). Global trends in diabetes com-plications: a review of current evidence. Diabetologia, 62(1): 3-16.
11. GBD 2021 Diabetes Collaborators (2023). Global, regional, and national burden of diabetes from 1990 to 2021, with pro-jections of prevalence to 2050: a system-atic analysis for the Global Burden of Disease Study 2021. Lancet, 402(10397): 203-34.
12. Lin X, Xu Y, Pan X, et al (2020). Global, re-gional, and national burden and trend of diabetes in 195 countries and territo-ries: an analysis from 1990 to 2025. Sci Rep, 10: 14790.
13. Balooch Hasankhani M, Mirzaei H, Kara-moozian A (2023). Global trend analysis of diabetes mellitus incidence, mortality, and mortality-to-incidence ratio from 1990 to 2019. Sci Rep, 13: 21908.
14. Essafi MA, Bouabdellaoui L, Aynaou H, et al (2022). Metabolic Syndrome in Pa-tients With Diabetes Mellitus. Cureus, 14(4): e24469.
15. Silveira Rossi JL, Barbalho SM, Reverete de Araujo R, et al (2022). Metabolic syn-drome and cardiovascular diseases: Go-ing beyond traditional risk factors. Dia-betes Metab Res Rev, 38(3): e3502.
16. Xu H, Li X, Adams H, et al (2018). Etiology of Metabolic Syndrome and Dietary In-tervention. Int J Mol Sci, 20(1): 128.
17. Singh A, Hardin BI, Singh D, et al (2023). Epidemiologic and Etiologic Considera-tions of Obesity. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
18. Singh A, Museedi AS, Grossman SA (2023). Acute Coronary Syndrome. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
19. Olvera Lopez E, Ballard BD, Jan A (2023). Cardiovascular Disease. [Updated 2023 Aug 22]. In: StatPearls [Internet]. Treas-ure Island (FL): StatPearls Publishing; 2023 Jan.
20. Renker M, Baumann S, Rier J, et al (2015). Imaging coronary artery disease and the myocardial ischemic cascade: clinical principles and scope. Radiol Clin North Am, 53(2): 261-69.
21. Powell EE, Wong VW, Rinella M (2021). Non-alcoholic fatty liver disease. Lancet, 397(10290): 2212-24.
22. Grundy SM, Cleeman JI, Daniels SR, et al (2005). Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation, 112(17): 2735-52.
23. Hussain A, Kaler J, Ray SD (2023). The Benefits Outweigh the Risks of Treating Hypercholesterolemia: The Statin Di-lemma. Cureus, 15(1): e33648.
24. Kaur J (2014). A comprehensive review on metabolic syndrome. Cardiol Res Pract, 2014: 943162.
25. Wells G, Shea B, O’Connell D, et al (2000). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa Hospital Research Institute.
26. Ahola AJ, Harjutsalo V, Thorn LM, et al. (2017). The association between macro-nutrient intake and the metabolic syn-drome and its components in type 1 di-abetes. Br J Nutr, 117(3): 450-456.
27. Blaslov K, Bulum T, Zibar K, Duvnjak L. (2015). Relationship between metabolic syndrome and meal-induced glucagon-like peptide-1 response in type 1 diabet-ic patients. J Diabetes, 7(3): 340-346.
28. Riccardo B, Cucinotta D, Fedele D, et al. (2006). The metabolic syndrome is a risk indicator of microvascular and macro-vascular complications in diabetes: re-sults from Metascreen, a multicenter di-abetes clinic-based survey. Diabetes Care, 29: 2701-2707.
29. Davis TME, Bruce DG, Davis WA. (2007). Prevalence and prognostic implications of the metabolic syndrome in commu-nity-based patients with type 1 diabetes: the Fremantle Diabetes Study. Diabetes Res Clin Pract, 78(3): 412-417.
30. Ferreira-Hermosillo A, Ramírez-Rentería C, Mendoza-Zubieta V, et al. (2014). Utility of the waist-to-height ratio, waist cir-cumference and body mass index in the screening of metabolic syndrome in adult patients with type 1 diabetes melli-tus. Diabetol Metab Syndr, 6(1): 32.
31. McGill M, Molyneaux L, Twigg SM, Yue DK. (2008). The metabolic syndrome in type 1 diabetes: does it exist and does it matter? J Diabetes Complications, 22(1): 18-23.
32. Ghosh S, Collier A, Hair M, Malik I, El-hadd T. (2010). Metabolic syndrome in type 1 diabetes. Int J Diabetes Mellit, 2: 38-42.
33. Hawa MI, Thivolet C, Mauricio D, et al. (2009). Metabolic syndrome and auto-immune diabetes: action LADA 3. Diabe-tes Care, 32: 160-164.
34. Huo L, Ji L, Deng W, et al. (2018). Age dis-tribution and metabolic disorders in people with type 1 diabetes in Beijing and Shantou, China: a cross-sectional study. Diabet Med, 35(6): 721-728.
35. Kilpatrick ES, Rigby AS, Atkin SL. (2007). Insulin resistance, the metabolic syn-drome, and complication risk in type I diabetes: “double diabetes” in the diabe-tes control and complications trial. Dia-betes Care, 30(3): 707-712.
36. Lee AS, Twigg SM, Flack JR. (2021). Meta-bolic syndrome in type 1 diabetes and its association with diabetes complica-tions. Diabet Med, 38: e14376.
37. Łuczyński W, Szypowska A, Głowińska-Olszewska B, Bossowski A. (2011). Overweight, obesity and features of metabolic syndrome in children with diabetes treated with insulin pump ther-apy. Eur J Pediatr, 170: 891-898.
38. Merger SR, Kerner W, Stadler M, et al. (2016). Prevalence and comorbidities of double diabetes. Diabetes Res Clin Pract, 119: 48-56.
39. Mollo A, Hernandez M, Marsal JR, et al. (2013). Latent autoimmune diabetes in adults is perched between type 1 and type 2: evidence from adults in one re-gion of Spain. Diabetes Metab Res Rev, 29: 446-451.
40. Nádas J, Putz Z, Nyi JF, et al. (2009). Cardi-ovascular risk factors characteristic for the metabolic syndrome in adult pa-tients with type 1 diabetes. Exp Clin En-docrinol Diabetes, 117: 107-112.
41. Pambianco G, Costacou T, Trevor JO. (2007). The prediction of major out-comes of type 1 diabetes: a 12-year pro-spective evaluation of three separate definitions of the metabolic syndrome and their components and estimated glucose disposal rate. Diabetes Care, 30(5): 1248-1254.
42. Rodrigues TC, Canani LH, Schvartzman P, Gross JL. (2011). Hypertension is the metabolic syndrome component most strongly associated with microvascular complications and coronary artery cal-cification in Type 1 diabetes. J Endocrinol Invest, 34: e58-63.
43. Saki F. (2016). Prevalence of metabolic syndrome in children with type 1 diabe-tes in South of Iran. J Compr Ped, 7(3): e37703.
44. Szadkowska A, Pietrzak I, Szlawska J, et al. (2009). Abdominal obesity, metabolic syndrome in type 1 diabetic children and adolescents. Pediatr Endocrinol Diabe-tes Metab, 15(4): 233-239.
45. Thorn LM, Forsblom C, Fagerudd J, et al. (2005). Metabolic syndrome in type 1 di-abetes: association with diabetic nephropathy and glycemic control (the FinnDiane study). Diabetes Care, 28(8): 2019-2024.
46. Valerio G, Iafusco D, Zucchini S, Mafeis C. (2012). Abdominal adiposity and cardio-vascular risk factors in adolescents with type 1 diabetes. Diabetes Res Clin Pract, 97(1): 99-104.
47. Osei-Yeboah J, Owiredu WK, Norgbe GK, et al. (2017). The Prevalence of Metabol-ic Syndrome and Its Components among People with Type 2 Diabetes in the Ho Municipality, Ghana: A Cross-Sectional Study. Int J Chronic Dis, 2017: 8765804.
48. Ju H, Bassett DS. (2020). Dynamic represen-tations in networked neural systems. Nat Neurosci, 23: 908–917.
49. Fatehi K, Priestley JL, Taasoobshirazi G. (2020). The expanded view of individual-ism and collectivism: One, two, or four dimensions? International Journal of Cross Cultural Management, 20(1): 7-24.
50. Alberti KGMM, Eckel RH, Grundy SM, et al. (2009). Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Pre-vention; National Heart, Lung, and Blood Institute; American Heart Associ-ation; World Heart Federation; Interna-tional Atherosclerosis Society; and In-ternational Association for the Study of Obesity. Circulation, 120(16): 1640-1645.
2. Shin JA, Lee JH, Lim SY, et al (2013). Meta-bolic syndrome as a predictor of type 2 diabetes, and its clinical interpretations and usefulness. J Diabetes Investig, 4(4): 334-43.
3. Kassi E, Pervanidou P, Kaltsas G, et al (2011). Metabolic syndrome: definitions and controversies. BMC Med, 9: 48.
4. Saklayen MG (2018). The Global Epidemic of the Metabolic Syndrome. Curr Hyper-tens Rep, 20(2): 12.
5. Vrablik M, Dlouha D, Todorovova V, et al (2021). Genetics of Cardiovascular Dis-ease: How Far Are We from Personal-ized CVD Risk Prediction and Man-agement? Int J Mol Sci, 22(8): 4182.
6. Moudatsou M, Stavropoulou A, Philalithis A, et al (2020). The Role of Empathy in Health and Social Care Professionals. Healthcare (Basel), 8(1): 26.
7. Guidi C, Traversa C (2021). Empathy in pa-tient care: from 'Clinical Empathy' to 'Empathic Concern'. Med Health Care Philos, 24(4): 573-85.
8. Khan MAB, Hashim MJ, King JK, et al (2020). Epidemiology of Type 2 Diabe-tes - Global Burden of Disease and Forecasted Trends. J Epidemiol Glob Health, 10(1): 107-11.
9. Adnan M, Aasim M (2020). Prevalence of Type 2 Diabetes Mellitus in Adult Popu-lation of Pakistan: A Meta-Analysis of Prospective Cross-Sectional Surveys. Ann Glob Health, 86(1): 7.
10. Harding JL, Pavkov ME, Magliano DJ, et al (2019). Global trends in diabetes com-plications: a review of current evidence. Diabetologia, 62(1): 3-16.
11. GBD 2021 Diabetes Collaborators (2023). Global, regional, and national burden of diabetes from 1990 to 2021, with pro-jections of prevalence to 2050: a system-atic analysis for the Global Burden of Disease Study 2021. Lancet, 402(10397): 203-34.
12. Lin X, Xu Y, Pan X, et al (2020). Global, re-gional, and national burden and trend of diabetes in 195 countries and territo-ries: an analysis from 1990 to 2025. Sci Rep, 10: 14790.
13. Balooch Hasankhani M, Mirzaei H, Kara-moozian A (2023). Global trend analysis of diabetes mellitus incidence, mortality, and mortality-to-incidence ratio from 1990 to 2019. Sci Rep, 13: 21908.
14. Essafi MA, Bouabdellaoui L, Aynaou H, et al (2022). Metabolic Syndrome in Pa-tients With Diabetes Mellitus. Cureus, 14(4): e24469.
15. Silveira Rossi JL, Barbalho SM, Reverete de Araujo R, et al (2022). Metabolic syn-drome and cardiovascular diseases: Go-ing beyond traditional risk factors. Dia-betes Metab Res Rev, 38(3): e3502.
16. Xu H, Li X, Adams H, et al (2018). Etiology of Metabolic Syndrome and Dietary In-tervention. Int J Mol Sci, 20(1): 128.
17. Singh A, Hardin BI, Singh D, et al (2023). Epidemiologic and Etiologic Considera-tions of Obesity. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
18. Singh A, Museedi AS, Grossman SA (2023). Acute Coronary Syndrome. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
19. Olvera Lopez E, Ballard BD, Jan A (2023). Cardiovascular Disease. [Updated 2023 Aug 22]. In: StatPearls [Internet]. Treas-ure Island (FL): StatPearls Publishing; 2023 Jan.
20. Renker M, Baumann S, Rier J, et al (2015). Imaging coronary artery disease and the myocardial ischemic cascade: clinical principles and scope. Radiol Clin North Am, 53(2): 261-69.
21. Powell EE, Wong VW, Rinella M (2021). Non-alcoholic fatty liver disease. Lancet, 397(10290): 2212-24.
22. Grundy SM, Cleeman JI, Daniels SR, et al (2005). Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation, 112(17): 2735-52.
23. Hussain A, Kaler J, Ray SD (2023). The Benefits Outweigh the Risks of Treating Hypercholesterolemia: The Statin Di-lemma. Cureus, 15(1): e33648.
24. Kaur J (2014). A comprehensive review on metabolic syndrome. Cardiol Res Pract, 2014: 943162.
25. Wells G, Shea B, O’Connell D, et al (2000). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa Hospital Research Institute.
26. Ahola AJ, Harjutsalo V, Thorn LM, et al. (2017). The association between macro-nutrient intake and the metabolic syn-drome and its components in type 1 di-abetes. Br J Nutr, 117(3): 450-456.
27. Blaslov K, Bulum T, Zibar K, Duvnjak L. (2015). Relationship between metabolic syndrome and meal-induced glucagon-like peptide-1 response in type 1 diabet-ic patients. J Diabetes, 7(3): 340-346.
28. Riccardo B, Cucinotta D, Fedele D, et al. (2006). The metabolic syndrome is a risk indicator of microvascular and macro-vascular complications in diabetes: re-sults from Metascreen, a multicenter di-abetes clinic-based survey. Diabetes Care, 29: 2701-2707.
29. Davis TME, Bruce DG, Davis WA. (2007). Prevalence and prognostic implications of the metabolic syndrome in commu-nity-based patients with type 1 diabetes: the Fremantle Diabetes Study. Diabetes Res Clin Pract, 78(3): 412-417.
30. Ferreira-Hermosillo A, Ramírez-Rentería C, Mendoza-Zubieta V, et al. (2014). Utility of the waist-to-height ratio, waist cir-cumference and body mass index in the screening of metabolic syndrome in adult patients with type 1 diabetes melli-tus. Diabetol Metab Syndr, 6(1): 32.
31. McGill M, Molyneaux L, Twigg SM, Yue DK. (2008). The metabolic syndrome in type 1 diabetes: does it exist and does it matter? J Diabetes Complications, 22(1): 18-23.
32. Ghosh S, Collier A, Hair M, Malik I, El-hadd T. (2010). Metabolic syndrome in type 1 diabetes. Int J Diabetes Mellit, 2: 38-42.
33. Hawa MI, Thivolet C, Mauricio D, et al. (2009). Metabolic syndrome and auto-immune diabetes: action LADA 3. Diabe-tes Care, 32: 160-164.
34. Huo L, Ji L, Deng W, et al. (2018). Age dis-tribution and metabolic disorders in people with type 1 diabetes in Beijing and Shantou, China: a cross-sectional study. Diabet Med, 35(6): 721-728.
35. Kilpatrick ES, Rigby AS, Atkin SL. (2007). Insulin resistance, the metabolic syn-drome, and complication risk in type I diabetes: “double diabetes” in the diabe-tes control and complications trial. Dia-betes Care, 30(3): 707-712.
36. Lee AS, Twigg SM, Flack JR. (2021). Meta-bolic syndrome in type 1 diabetes and its association with diabetes complica-tions. Diabet Med, 38: e14376.
37. Łuczyński W, Szypowska A, Głowińska-Olszewska B, Bossowski A. (2011). Overweight, obesity and features of metabolic syndrome in children with diabetes treated with insulin pump ther-apy. Eur J Pediatr, 170: 891-898.
38. Merger SR, Kerner W, Stadler M, et al. (2016). Prevalence and comorbidities of double diabetes. Diabetes Res Clin Pract, 119: 48-56.
39. Mollo A, Hernandez M, Marsal JR, et al. (2013). Latent autoimmune diabetes in adults is perched between type 1 and type 2: evidence from adults in one re-gion of Spain. Diabetes Metab Res Rev, 29: 446-451.
40. Nádas J, Putz Z, Nyi JF, et al. (2009). Cardi-ovascular risk factors characteristic for the metabolic syndrome in adult pa-tients with type 1 diabetes. Exp Clin En-docrinol Diabetes, 117: 107-112.
41. Pambianco G, Costacou T, Trevor JO. (2007). The prediction of major out-comes of type 1 diabetes: a 12-year pro-spective evaluation of three separate definitions of the metabolic syndrome and their components and estimated glucose disposal rate. Diabetes Care, 30(5): 1248-1254.
42. Rodrigues TC, Canani LH, Schvartzman P, Gross JL. (2011). Hypertension is the metabolic syndrome component most strongly associated with microvascular complications and coronary artery cal-cification in Type 1 diabetes. J Endocrinol Invest, 34: e58-63.
43. Saki F. (2016). Prevalence of metabolic syndrome in children with type 1 diabe-tes in South of Iran. J Compr Ped, 7(3): e37703.
44. Szadkowska A, Pietrzak I, Szlawska J, et al. (2009). Abdominal obesity, metabolic syndrome in type 1 diabetic children and adolescents. Pediatr Endocrinol Diabe-tes Metab, 15(4): 233-239.
45. Thorn LM, Forsblom C, Fagerudd J, et al. (2005). Metabolic syndrome in type 1 di-abetes: association with diabetic nephropathy and glycemic control (the FinnDiane study). Diabetes Care, 28(8): 2019-2024.
46. Valerio G, Iafusco D, Zucchini S, Mafeis C. (2012). Abdominal adiposity and cardio-vascular risk factors in adolescents with type 1 diabetes. Diabetes Res Clin Pract, 97(1): 99-104.
47. Osei-Yeboah J, Owiredu WK, Norgbe GK, et al. (2017). The Prevalence of Metabol-ic Syndrome and Its Components among People with Type 2 Diabetes in the Ho Municipality, Ghana: A Cross-Sectional Study. Int J Chronic Dis, 2017: 8765804.
48. Ju H, Bassett DS. (2020). Dynamic represen-tations in networked neural systems. Nat Neurosci, 23: 908–917.
49. Fatehi K, Priestley JL, Taasoobshirazi G. (2020). The expanded view of individual-ism and collectivism: One, two, or four dimensions? International Journal of Cross Cultural Management, 20(1): 7-24.
50. Alberti KGMM, Eckel RH, Grundy SM, et al. (2009). Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Pre-vention; National Heart, Lung, and Blood Institute; American Heart Associ-ation; World Heart Federation; Interna-tional Atherosclerosis Society; and In-ternational Association for the Study of Obesity. Circulation, 120(16): 1640-1645.
| Files | ||
| Issue | Vol 54 No 1 (2025) | |
| Section | Review Article(s) | |
| Keywords | ||
| Metabolic syndrome Diabetes mellitus Meta-analysis Body mass index Blood pressure | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Zhang M, Lou B, Huang W. Navigating Metabolic Complexity and in-Depth Analysis of Metabolic Syndrome among Diabetes Mellitus Patients: A Systematic Review and Meta-Analysis. Iran J Public Health. 2025;54(1):48-61.
