Metabolic Syndrome

Question 1

What are the criteria for diagnosing metabolic syndrome?

Answer 1

When 3 or more of the following 5 criteria are present:
• Waist circumference—men >40 inches; women >35 inches
• Triglycerides >150 mg/dL
• HDL cholesterol—men <40 mg/dL; women <50 mg/dL
• Blood Pressure >130/85
• FBS >100 mg/dL

Question 2

What are the criteria for diagnosing prediabetes?

Answer 2

BG 100-125 fasting, A1C of 5.7-6.4%

Question 3

What are the criteria for diagnosing diabetes?

Answer 3

BG 126 fasting, A1C of >6.5%

Question 4

Type 1 Diabetes

Answer 4

due to b cell destructions, usually leading to absolute insulin deficiency. Sx: rapid onset of symptoms, weight loss, ketones in urine and blood, kussmaul respirations.

Question 5

Type 2 Diabetes

Answer 5

progressive loss of insulin secretion on the background of insulin resistance. Sx. Wt gain, no ketones in blood/urine, may present with end organ damage-paresthesias, vision loss, etc.

Question 6

Gestational DM

Answer 6

diabetes diagnosed in 2nd or 3rd trimester that is not clearly overt diabetes-2 hour OGTT 24-28 weeks using 75 gram glucose load after 8 hour fast. Diagnosis made if fasting is greater than 92, 1 hour glucose is >180 or if 2 hour is >153.

Question 7

Metabolic syndrome

Answer 7

root cause is insulin resistance; more insulin is needed to keep patient euglycemic. This syndrome is related to HTN, obesity and dyslipidemia. Sx: Waist circumference >40 inches in men, 35 in women, Triglycerides >150, HDL <40 males, <50 females, Blood pressure >130/85 and FBS >100

Question 8

Identify the components of a treatment plan for Metabolic Syndrome

Answer 8

If patient presents with clinical features of metabolic syndrome, need annual screening for: hyperglycemia, glucose intolerance, T2DM, CV complications

Question 9

Describe indications for screening for prediabetes and diabetes

Answer 9

Screen all adults with BMI >25 and additional risk factors

Question 10

DM risk factors

Answer 10

physical inactivity
1st degree relative with diabetes
high risk race/ethnicity
women who delivered a baby weighing >9lbs or were diagnosed with GDM
HTN
HDL-C <35 or TG >250
A1C >=5.7%
severe obesity
acanthosis nigricans
PCOS
Hx of CVD

Question 11

Define ADA lifestyle and medication recommendations for diet, physical activity, and weight loss.

Answer 11

● Initial target: 1-2 pound/week weight loss ● Long-range goal: 7% loss of body weight
● Increase physical activity to ≥150 min/week ● Individualized medical nutrition therapy
● Provided by a registered dietitian
Reduce caloric intake by 500-1000 kcal/day (depending on starting weight)
● Reduce dietary fat
● Limit intake of sugar-sweetened beverages
● Dietary fiber intake of 14 grams/1000 kcal
● Whole grains are 50% of grain intake
● 5-7 servings of fruits and vegetables a day

Question 12

Treatment for prediabetes

Answer 12

• Educate patient about his/her status
• Opportunity to prevent or delay onset of diabetes
• Lifestyle KEY
• Pts should be referred to an intensive diet and physical activity behavioral counseling. Target loss of 7% of body weight, increase exercise to 150min/week
• METFORMIN should be considered for prediabetes especially for those with BMI >35, aged <60, and women with prior gestational diabetes.
• Monitor annually for the development for diabetes