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Question: Many patients ask whether they have insulin resistance or metabolic syndrome. What is the best way to answer, and are there any laboratory tests that can help?
Answer: The controversial metabolic syndrome has several names, including the insulin resistance syndrome and the cardiovascular dysmetabolic syndrome.
Recently, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) jointly recommended caution in labeling patients as having the metabolic syndrome and prescribing treatment for this diagnosis1 (DOC News, October 2005). Doing so misleads patients into believing they have some kind of disease, ADA and EASD contend, when what they really have is a cluster of cardiovascular risk factors that should be treated individually. Clearly, further research is needed to define more specifically these clinical findings and their long-term implications.
For purposes of answering this question, we're going to discuss treating the metabolic syndrome risk factors identified in 2001 by the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol of the National Cholesterol Education Program (NCEP).2 NCEP defined the metabolic syndrome as a constellation of five elements; if an individual has three or more of these, they have the metabolic syndrome, according to NCEP.
One of the five features is central abdominal obesity, meaning a waist circumference >102 cm (40 in) for men and >88 cm (35 in) for women. A simple tape measure can be used to determine waist circumference. With the patient in a relaxed state, measure the largest circumference between the belly button and the top of the hip bone.
Blood tests can be used to check for three other syndrome features:
triglycerides >150 mg/dl; HDL cholesterol <40 mg/dl in men or <50
mg/dl in women; and fasting blood glucose 
110 mg/dl. (The ADA has adopted
>100 mg/dl as the cut point between normal and abnormal blood glucose, thus
encouraging clinicians to make the diagnosis earlier.)
Finally, measuring blood pressure will determine if a patient meets the
fifth criterion, a systolic pressure 130 mmHg or a diastolic reading
85 mmHg.
Early diagnosis of the components of metabolic syndrome is important because of their known association with cardiovascular risk, demonstrated by many recent trials. Patients with insulin resistance or impaired fasting glucose are at increased risk of accelerated cardiovascular problems, and those with diabetes have a two- to fourfold higher risk of myocardial infarction, stroke, and death from cardiovascular disease compared with individuals without diabetes.
Of great concern is a recent study showing that cardiovascular risk factors associated with insulin resistance in children persist into late adolescence, thus making it imperative that clinicians consider cardiovascular risk factors as early as childhood.3
Frontline therapy should be weight loss and exercise. The Diabetes
Prevention Program demonstrated weight loss with exercise lowers the risk for
developing diabetes for high-risk individuals by
>50%.4 The first
key, however, is heightened awareness of the presence of any of the five risk
factors. 
Footnotes
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Mary Ann Emanuele, MD, is a professor of medicine, and cell biology, neurobiology, and anatomy at Loyola University of Chicago Stritch School of Medicine.
Nicholas V. Emanuele, MD, is a professor and director of the division of endocrinology at Loyola University and a staff physician at the VA Hines (Ill.) Hospital.
References
2. Expert Panel on Detection, Evaluation, and Treatment of High Blood
Cholesterol in Adults: Executive summary of the third report of the National
Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation,
and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).
JAMA 285:2486–2497, 2001.
3. Reaven PD, Traustadottir T, Brennan J, et al.: Cardiovascular risk
factors associated with insulin resistance in children persist into late
adolescence. Diabetes Care 28:148–150, 2005.
4. Knowler WC, Barrett-Connor E, Fowler SE, et al., for the Diabetes
Prevention Program Research Group: Reduction in the incidence of type 2
diabetes with lifestyle intervention or metformin. N Engl J
Med 346:393–403, 2002.
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