The American Association of Clinical Endocrinologists and the American College of Endocrinology have weighed in on the growing debate surrounding the term metabolic syndrome by reaffirming their 2003 position statement regarding what they call insulin resistance syndrome.
The new two-page document, “American College of Endocrinology/American Association of Clinical Endocrinologists Reaffirmation of the 2003 ACE Insulin Resistance Syndrome (IRS) Position Statement” (available at www.aace.com
In September, the American Diabetes Association (ADA) and the European Society for the Study of Diabetes (EASD) issued a joint statement calling the term metabolic syndrome into question, citing a lack of data to demonstrate that the term denotes a useful marker for cardiovascular disease beyond its individual components, as well as the concern that patients might misunderstand the implications of the diagnosis (Diabetes Care 2005;28:2289–304).
Then, in mid-October, the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI) issued a joint statement affirming the usefulness of the metabolic syndrome term, as originally stated in the 2001 National Cholesterol Education Program Adult Treatment Panel Report III.
The new AHA/NHLBI document, which was in the works before the ADA/EASD statement came out, also clarifies some issues and makes minor modifications to the Adult Treatment Panel III definition of metabolic syndrome (Circulation 2005;112:e285–90).
For their part, the American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE) still prefer the term insulin resistance syndrome, because in contrast to the poorly defined word metabolic, insulin resistance syndrome “offers a clear statement of the presumed pathogenesis of the syndrome,” according to their earlier document (Endocrine Practice 2003;9:240–52).
Regardless of the term used—metabolic syndrome or insulin resistance syndrome—the ACE/AACE position differs from that of the ADA/EASD, which states that neither entity is well defined enough to qualify as a syndrome.
The ACE/AACE, however, said “the term syndrome (whether metabolic or insulin resistant) is conceptually attractive and clinically useful” and the two terms together provide “a simple construct to characterize the type of patients that clinicians see daily.”
But the two endocrinologist groups do agree with the ADA/EASD statement that such syndromes should be specifically distinguished from type 2 diabetes and cardiovascular disease, because the whole idea is to identify individuals at high risk for these consequences before they occur.
Moreover, the ACE/AACE position emphasizes the importance of recognizing other associated disease consequences beyond cardiovascular disease, such as polycystic ovary syndrome and nonalcoholic fatty liver disease.