Prevalence and Association of Criteria of Metabolic Syndrome in a Cohort of Diabetes Type 2 in Saint-Louis

Introduction: The metabolic syndrome is characterized by an aggregate of metabolic disorders whose coexistence in the same individual can correspond on the one hand to a common pathophysiological mechanism and on the other hand to expose the subject to an increased risk of cardiovascular dis-eases. The prevalence of the metabolic syndrome is increasing rapidly in both developed and developing countries, but has been poorly described in sub-Saharan Africa. Most of them reported the components of the metabolic syndrome only in isolation. Methods: This cross-sectional study carried out on a cohort of 76 patients followed at the Sait-louis regional hospital used the definition criteria of the International Diabetes Federation. Results: The average age of our patients is 56.92 with extremes ranging from 32 to 80 years old. The sex ratio is 0.49. The average duration of diabetes progression is 68 months. The prevalence of the metabolic syndrome in this population is 67.1%. Abdominal obesity and high blood pressure are the most commonly found criteria. Abdominal obesity was the most associated component of MS in both sexes followed by high blood pressure. We found relatively weak data for dyslipidemia, especially hypertriglyceridemia. HypoHD is dyslipidemia more found in our cohort: in 45% of women and 21% of men. Conclusion: The management of the metabolic syndrome therefore requires fighting against all the factors that compose


Introduction
Type 2 diabetes, a true global pandemic and a public health problem [1] [2] [3] [4] [5], is associated with comorbidities, such as obesity, dyslipidemias, high blood pressure and comorbidities that may be present in the metabolic syndrome. These comorbidities are recognized as cardiovascular risk factors, increasing the morbidity and mortality of patients [6].
This syndrome results from the association of 3 types of alterations: the accumulation of adipose tissue (TA) in particular at the level of the muscle and the liver, leading to a lipotoxicity of free fatty acids (FFA) and their derivatives at the level of these insulin-sensitive organs; alteration of the endocrine function of TA with modification of adipokine production (decrease of insulin-sensitizing adiponectin, increase of adipokines involved in insulin resistance); and macrophage infiltration resulting in the development of a pro-inflammatory state (inappropriate secretion of TNF-α and IL-1) leading to insulin resistance and hyperinsulinism [6] [7] [8].
The growing interest in metabolic syndrome comes from the fact that it predisposes to ischemic cardiovascular disease. In addition, its frequency and severity make it a major public health problem.
The main objective of this study is to determine the prevalence of metabolic syndrome in a population of diabetics followed in northern Senegal. The secondary objectives are to describe the association of the different criteria of the metabolic syndrome.

Methods
The population of the study is made up of 76 patients received in consultation at the department of internal medicine of the Regional Hospital Center of Saint-Louis from January to July 2018. Inclued all patients diagnosed with type 2 diabetes after free and informed consent.
Patients were classified into three groups, depending on the number of Metabolic Syndrome criteria present.
A systematic clinical examination as well as a compendium of ongoing diabetes treatments was performed in all patients.

Results
The average age of our patients is 56.92 with extremes ranging from 32 to 80 years old. The sex ratio is 0.49. The average duration of diabetes progression is 68 months.
The prevalence of metabolic syndrome is 67.1% and the distribution of metabolic syndrome criteria is shown in Table 1.
Of the components of the metabolic syndrome, abdominal obesity was the most common with 64.4% followed by 51.3%. The study of type 2 diabetic patients with metabolic syndrome showed: -an average age of 57.9 years; -a sex ratio (m/f): 0.41; -a sedentary lifestyle at 51.31%.
The averages of the different variables by sex are presented in Table 2 and Figure 1.
We did not find a relationship between sex and the presence of the metabolic syndrome (Khi2 = 0.85).
Therapeutically, 84% of the study population are treated with oral antidiabetic agents (ADO), 10% by insulin and the rest by insulin-ADO combination.

Discussion
In our study, 67% of diabetic patients met the FID criteria of the metabolic syndrome. The comparison of prevalence levels by country in different studies is biased by the variety of definitions used. While the definitions agree on the essential components of the MS, they differ on the critical values used for each of its components and on the combinations of criteria used to define the MS.
However, regardless of the definition used for the prevalence assessment of DM, the results highlight a high prevalence of this syndrome in developed countries, as well as a significant increase in developing countries [ [11], most other countries do not. A survey conducted in the Abidjan general population found 5% of metabolic syndrome [12]. In a second comparative Ivorian study, 38% of metabolic syndrome was observed in diabetics compared with 2% in non-diabetics [13].
In Guinea, Diallo et al. found a prevalence of 56% in a cohort of type 2 diabetics closer to our results [14] [15].
In our population, obesity and high blood pressure are the defining criteria for the metabolic syndrome most commonly associated with type 2 diabetes.
Monabeka reported that abdominal obesity was the most associated component of MS in both sexes [16]. Doupa et al. reveals, in a study made in the general population of Saint-Louis, 25% of obesity (BMI >30 kg/m 2 ) and 34.8% of abdominal obesity [17].
Classically, dyslipidemia in type 2 diabetes is characterized by both quantitative and qualitative lipoprotein abnormalities with, typically, a moderate increase in plasma triglycerides (TG), a variable lowering of HDL-cholesterol (HDL-c). and an accumulation of residual lipoproteins enriched in cholesterol (remnants) [18].
HypoHDLemia is dyslipidemia is more found in our cohort: in 45% of women and 21% of men. Our figures are close to those described by concordance with the data of Fezeu et al. in Cameroon [19].

Conclusions
Our work confirms the high prevalence of metabolic syndrome in sub-Saharan Africa and particularly in type 2 diabetics. This syndrome must be systematically detected in daily practice and awareness campaigns on the cardiovascular risks related to this syndrome must be undertaken, in order to inform and sensitize our populations to a better lifestyle.

Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this paper.