Evaluating CMR

AACE

The American Association of Clinical Endocrinologists (AACE) presented its official position on the “insulin resistance syndrome” in 2003 (Table) (11). Unlike WHO and EGIR, AACE deliberately chose not to provide a specific definition of the insulin resistance syndrome, suggesting instead that diagnosis should depend on individual clinical judgement. AACE’s decision was based on the fact that the field is evolving rapidly and that it did not feel comfortable making a firm decision on proposed criteria cut-off values until more data was available. Regarding criteria to be included, AACE adopted the same clinical criteria as the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III or ATP III) for blood pressure and lipid criteria (which were also endorsed by the International Diabetes Federation). Blood pressure above 130/85 mmHg, triglyceride concentrations above 1.7 mmol/l (150 mg/dl), and HDL cholesterol concentrations below 1.04 mmol/l (40 mg/dl) for men and below 1.29 mmol/l (50 mg/dl) for women are therefore abnormalities of the insulin resistance syndrome. AACE also stated that fasting plasma glucose concentrations between 6.1 mmol/l (110 mg/dl) and 6.9 mmol/l (125 mg/dl) and plasma glucose concentrations between 7.8 (140 mg/dl) and 11.1 mmol/l (200 mg/dl) after a two-hour glucose challenge should be considered another syndrome abnormality. The two-hour oral glucose tolerance test is recommended for at-risk individuals who do not meet the proposed criteria for the insulin resistance syndrome. The Task Force appointed by AACE suggested that other criteria should be added or revised for assessment of the syndrome.