Treatment of the Metabolic Syndrome in Daily Clinical Practice: Algorithms
All clinicians must have a measuring tape on their desk. This is as important as having a blood pressure metre and scales in their office. If the metabolic syndrome is suspected, waist circumference must be measured. This must be done in patients at high
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Henning Beck-Nielsen
15.1
How to Treat Patients with Metabolic Syndrome in Daily Clinical Practice
All clinicians must have a measuring tape on their desk. This is as important as having a blood pressure metre and scales in their office. If the metabolic syndrome is suspected, waist circumference must be measured. This must be done in patients at high risk, see Fig. 15.1. If increased waist circumference is measured, serum triglyceride, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and fasting plasma glucose must also be measured. Based on these measurements, the diagnosis “metabolic syndrome” can be made, and a formal basis for intervention is obtained. The International Diabetes Federation (IDF) has recently formulated a definition of the metabolic syndrome, and we recommend using this definition in clinical practice [1]. In patients with metabolic syndrome, the following measurements may also be considered in addition to the above-mentioned measurements: measurement of the liver function—among others serum alanine aminotransferase and serum urate— and androgen status for both genders and oestrogen status in women. Figure 15.1 presents a flowchart for diagnosis of the metabolic syndrome in daily clinical practice.
15.2
Treatment of Patients with Metabolic Syndrome
The whole point of diagnosing the metabolic syndrome is that it becomes possible to intervene against the syndrome itself, i.e. against insulin resistance, hyperinsulinism and visceral obesity. The pathophysiological model presented in Fig. 1.1 (Chap. 1) indicates that primarily energy intake must be reduced and weight loss induced.
H. Beck-Nielsen (*) Department of Endocrinology M, Odense University Hospital, Kloevervaenget 6, 4th floor, 5000 Odense C, Denmark e-mail: [email protected] H. Beck-Nielsen (ed.), The Metabolic Syndrome, DOI 10.1007/978-3-7091-1331-8_15, # Springer-Verlag Wien 2013
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Risk factors of the metabolic syndrome (MS)*
Waist circumference Higher than the recommended values for different ethnic groups
Normal
Blood pressure Lipid status Fasting plasma glucose
MS
General health guidance based on existing risk factors
Annual control of waist circumference
¸ MS
Liver parametres Cardiovascular status
Annual control of blood pressure, lipids and fasting plasma glucose
Intervention and control
*Risk factors: Increased body mass index, arteriosclerotic cardiovascular disease, hypertension, reduced physical activity, disposition of the metabolic syndrome, hepatic steatosis, polycystic ovary syndrome, hypogonadism in men and women.
Fig 15.1 Plan of action for examination and treatment of patients at risk of the metabolic syndrome in daily clinical practice
15.2.1 Lifestyle Intervention The first steps to be taken when treating the metabolic syndrome are to ensure a lifestyle reducing energy intake and/or increasing energy consumption (see Chap. 7) [2]. This can be done as follows: • Stimulation of weight loss; a reduction of ab
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