News Article
Endocrine Society Suggests Strategies to Prevent Diabetes and Heart Disease
A new clinical practice guideline from the Endocrine Society gives clinicians strategies to keep type 2 diabetes and cardiovascular disease at bay in adults with metabolic risk factors.
The metabolic risk factors that should raise red flags for primary care clinicians include enlarged waist circumference, hypertension, and elevated plasma glucose levels.
"This guideline focuses on the population of individuals with the components of the metabolic syndrome who do not yet have diagnosed cardiovascular disease or type 2 diabetes mellitus, and on the steps that can be taken to prevent these two diseases," the guideline authors said in an introductory statement.
The guideline urges health care providers to make metabolic risk reduction part of their regular practice by measuring waist circumference, blood pressure, fasting lipid profiles, and fasting glucose as part of every routine clinical visit.
If patients approach or fall into the at-risk category for any of these measures, they should receive counseling about how to reduce their disease risk with lifestyle management, which includes a healthy diet, adequate exercise, and appropriate weight loss if needed.
The guideline appeared in print in the October issue of the Journal of Clinical Endocrinology and Metabolism and is now available online at www.endojournals.org.
It defines metabolic risk as a person's risk for CVD and type 2 diabetes based on several elements, including elevated triglycerides, reduced HDL cholesterol, increased plasma glucose levels, hypertension, enlarged waist circumference, a prothrombotic state, and a proinflammatory state.
The guideline also recommends a global risk assessment every 10 years for all patients who meet the criteria for metabolic risk, to check for signs of coronary heart disease and cardiovascular disease. The LDL cholesterol measure should be used to target lipoprotein-lowering therapy if lifestyle modification has been insufficient.
In addition, patients who meet criteria for prediabetes based on measurements taken at a routine clinical visit should be screened for diabetes at 1- to 2-year intervals using either a fasting plasma glucose test or a 2-hour oral glucose tolerance test.
The members of the Endocrine Society task force who developed the guideline stated that they did not attempt to agree on a specific definition of the metabolic syndrome. The society suggests that physicians screen for metabolic risk factors using the American Heart Association/National Heart, Lung, and Blood Institute definition at each clinical visit because it is easy and convenient to use in the office setting.
"The finding of three or more components especially should alert the clinician to a patient at metabolic risk (a higher risk for CVD and type 2 diabetes mellitus)," the guideline states.
The task force members said in their introduction that the Endocrine Society guidelines are meant to assist clinicians. The current guideline should not be considered inclusive or exclusive of other approaches to care, and it does not establish a standard of care or guarantee a specific outcome, they noted.
Dr. James L. Rosenzweig of Boston University, chair of the task force that developed the guidelines, stated that he had no financial conflicts to disclose. Other members of the task force had no financial interests to disclose, but they have served on speakers bureaus for multiple pharmaceutical companies including Novartis, Pfizer Inc., Merck and Co., and GlaxoSmithKline.
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