Docs Should Screen for Metabolic Syndrome
— Updated guideline from endocrine groups aims to prevent type 2 diabetes and atherosclerotic coronary vascular disease (blocked arteries).
by Kristen Monaco, Staff Writer, MedPage Today July 31, 2019
This article is from MedPage Today.
Adults ages 40 to 75 should be regularly screened for “all five components” of metabolic syndrome, according to an updated clinical practice guideline from The Endocrine Society.
In the revision of a 2008 guideline, healthcare providers are advised to measure
each of the following during office visits:
1. Blood pressure
2. Waist circumference
3. Fasting triglycerides
4. LDL and HDL cholesterol
5. Blood glucose
The recommendation of regular screening is intended for the primary prevention of atherosclerotic cardiovascular disease (CVD) and type 2 diabetes in adults, ages 40 to 75, explained writing committee chair James Rosenzweig, MD, of Hebrew Rehabilitation Hospital in Boston, and colleagues.
Although the recommendation is focused on a particular age group, the guideline can also be applied to patients outside the age range, they stated in the Journal of Clinical Endocrinology & Metabolism.
Co-sponsored by the American Diabetes Association and the European Society of Endocrinology, the guideline highlights the importance of regular screening for all five of these factors of metabolic syndrome in order to identify patients at “high metabolic risk,” defined as possessing at least three of the components.
“Doctors haven’t been doing enough to measure waist circumference, but it’s essential to identifying patients at metabolic risk earlier and preventing more cases of heart disease and diabetes,” Rosenzweig said in a statement.
Prevention is key, the guideline underscored, recommending lifestyle modification as the first-line therapy for all individuals identified as being at high metabolic risk.
“We emphasize the importance of lifestyle, dietary, and behavioral changes as the first line treatment. However, treatment with medication is appropriate if goals are not met with lifestyle changes alone,” Rosenzweig added.
Primary care providers, endocrinologists, geriatricians, cardiologists, and other “relevant providers should encourage individuals to join comprehensive programs led by trained health professionals that support the adoption of healthy lifestyles, including diet and physical activity, aiming for moderate but sustained weight loss,” the committee wrote.
Beyond initial lifestyle intervention, prevention of atherosclerotic CVD and type 2 diabetes should be viewed as two separate entities, which is a key update from the 2008 guideline.
For patients that don’t already have atherosclerotic CVD and/or type 2 diabetes, healthcare providers should screen for these five factors of metabolic syndrome every 3 years. However, they also recommend measuring waist circumference every year.
In addition to lifestyle and behavioral therapy as first-line defense, the guideline also advocates that high-risk patients undergo a global assessment of 10-year risk for coronary heart disease, or atherosclerotic CVD, prior to initiating pharmacological or other medical interventions. For example, for patients with an LDL cholesterol of ≥190 mg/dL, cholesterol reduction with high-intensity statin therapy is recommended with a goal of achieving a reduction of ≥50%.
The guideline authors also suggest patients with a blood pressure >130/80 mmHg employ lifestyle management to reduce their risk for atherosclerotic CVD.
As for prevention of diabetes, patients with established prediabetes — defined as a fasting blood glucose from 100-125 mg/dL — should undergo yearly type 2 diabetes screening. Specifically, the guideline recommends using HbA1c, fasting glucose, or 2-hour glucose along with a second confirmatory test with a new blood sample when measuring glycemia.
Again, lifestyle modification is recommended as the first-line of defense against type 2 diabetes. However, if patients are not responding to lifestyle intervention, metformin is recommended as the first pharmacological intervention to reduce glucose levels.
The guideline highlighted gaps that still exist in the literature, such as a lack of data on all the underlying factors that contribute to metabolic syndrome, including inflammation of the liver and blood vessels.
Other research areas that require exploration include the benefits of bariatric surgery in the treatment of CVD and diabetes, noninvasive tests to measure vascular dysfunction, and public health-based prevention strategies.
Last Updated July 31, 2019
The guideline was supported by the Endocrine Society.
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