Metabolic Syndrome and Type 2 DM

Question 1

NCEP/ATP III criteria for diagnosis of metabolic syndrome

Answer 1

Abdominal obesity
Waist ≥ 40 inches (102 cm) men
Waist ≥ 35 inches (88cm) women

Triglycerides ≥ 150 mg/dL

HDL cholesterol
< 40 mg/dL men, < 50 mg/dL women

BP ≥ 130/85

Fasting plasma glucose ≥ 100 mg/dL

(NEED 3 of the 5)

Question 2

IDF criteria for diagnosis of metabolic syndrome

Answer 2

Increased waist circumference (ethnic specific) PLUS 2 of the following:

Triglycerides >150 mg/dL

HDL < 40 mg/dL men, < 50 mg/dL women

SBP > 130 mmHg or DBP > 85 mmHg

Fasting blood sugar > 100 mg/dL

Question 3

Criteria for diagnosis of type 2 diabetes

Answer 3

A1C ≥ 6.5%

Fasting plasma glucose ≥ 126 mg/dL
At least an 8 h fast

2 h plasma glucose ≥ 200 mg/dL during an OGTT

Classic symptoms of hyperglycemia or hyperglycemic crisis and a random plasma glucose of ≥ 200 mg/dL

Question 4

Pharmacotherapy for T2DM

Answer 4

First line drug therapy is metformin

Severe symptoms or markedly elevated A1C consider insulin therapy to start

Not to goal with max noninsulin monotherapy in 3-6 months then add another agent

Question 5

Hypoglycemia

Answer 5

Symptoms: confusion, diaphoresis, tachycardia, palpitations, weakness

15-20 g glucose or any form of carbohydrate

Question 6

Bariatric surgery

Answer 6

BMI ≥ 35

Especially for difficult to control DM with associated comorbidities

Question 7

Treatment of albuminuria

Answer 7

> 30 mg/day urinary albumin excretion
ACE inhibitor or angiotensin receptor blocker (ARB)

Reduction of dietary protein intake
.8 to 1 g/kg body weight