From the Guidelines
Metabolic diseases, including metabolic syndrome, should be managed primarily through lifestyle modifications, such as a balanced diet, regular physical activity, and maintaining a healthy weight, as these interventions have been shown to improve insulin sensitivity and reduce the risk of developing type 2 diabetes and cardiovascular disease 1.
Key Components of Management
- Lifestyle modifications:
- Balanced diet
- Regular physical activity
- Maintaining a healthy weight
- Monitoring and management of risk factors:
- Hypertension
- Dyslipidemia
- Insulin resistance
Pharmacological Interventions
- For patients with hypertension, consider using a blocker of the renin-angiotensin system, followed by a calcium antagonist or a low-dose thiazide diuretic if needed 1
- For patients with dyslipidemia, consider using statins
- For patients with diabetes, consider using metformin or other antidiabetic drugs
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of metabolic diseases are crucial to prevent complications such as cardiovascular disease, neuropathy, and organ damage. Regular monitoring of blood glucose, lipid levels, and blood pressure is essential for effective management.
Underlying Pathophysiology
The underlying pathophysiology of metabolic diseases involves disruptions in cellular energy production, hormone regulation, or enzyme function, which explains why a multifaceted approach to treatment is often required.
Recent Guidelines
Recent guidelines, such as the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline, emphasize the importance of lifestyle modifications and provide recommendations for the management of metabolic syndrome and other metabolic diseases 1.
From the Research
Definition and Risk Factors of Metabolic Disease
- Metabolic syndrome is defined as a condition characterized by a set of clinical criteria: insulin resistance, visceral obesity, atherogenic dyslipidemia, and hypertension 2
- The major risk factors leading to the epidemic of this syndrome are visceral obesity, physical inactivity, and an atherogenic diet 2
- Metabolic syndrome is diagnosed by a co-occurrence of three out of five of the following medical conditions: abdominal obesity, elevated blood pressures, elevated glucose, high triglycerides, and low high-density lipoprotein-cholesterol (HDL-C) levels 3
Treatment and Management of Metabolic Disease
- The first step in management of patients with metabolic syndrome should be focused on lifestyle modifications (eg, weight loss and physical activity) 2
- Lifestyle modification can be summarized as dietary changes, exercise, and smoking cessation 4
- A realistic goal for weight reduction should be 7% to 10% over 6 to 12 months 2
- Medication therapy is a critical step in the management of patients with metabolic syndrome when lifestyle modifications fail to achieve the therapeutic goals 2
- Pharmacological agents that deal with obesity, diabetes, hypertension, and dyslipidemia can be used singly or in combination: anti-obesity drugs, thiazolidinediones, metformin, statins, fibrates, renin-angiotensin system blockers, glucagon like peptide-1 agonists, sodium glucose transporter-2 inhibitors, and some antiplatelet agents such as cilostazol 3
Pharmacological Treatment of Metabolic Disease
- Insulin-sensitizing agents, such as metformin and thiazolidinediones, are used to treat metabolic syndrome 5
- Statins and fibrates, or angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are the first-line lipid-modifying or antihypertensive drugs 5
- Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers reduce the odds of developing new onset type 2 diabetes and also decrease albuminuria 6
- Long-acting calcium channel blockers are also recommended in hypertensive patients with metabolic syndrome; these drugs also improve insulin resistance 6
Lifestyle Modifications for Metabolic Disease
- Healthier eating and regular exercise greatly reduce waistline and body mass index, lower blood pressure and improve lipid profile 5
- Physical activity is associated with successful weight reduction and these therapeutic lifestyle changes can reduce by half the progression to new-onset diabetes in patients with metabolic syndrome 2
- Physical activity recommendations should include practical, regular, and moderated regimens of exercise, with a daily minimum of 30 to 60 minutes 2
- An equal balance between aerobic exercise and strength training is advised 2