Overview of prevention and control
Because every component of metabolic syndrome is a risk factor of cardiovascular disease, and their combined effect is stronger, some people call metabolic syndrome "death quartet" (central obesity, hyperglycemia, hypertriglyceridemia and hypertension). Therefore, metabolic syndrome is a universal and economical concept for the diagnosis and treatment of a group of highly related diseases, which requires lifestyle intervention (such as losing weight, increasing physical exercise and mental coordination), lowering blood sugar and regulating blood sugar.
All treatments should focus on reducing various risk factors. Including effective weight loss; Reduce insulin resistance; Good blood sugar control; Improve lipid metabolism disorder and control blood pressure.
lose weight
Any obese diabetic needs to lose weight. Mainly through diet and lifestyle changes and necessary drugs. Studies have shown that it is less likely for obese people to lose weight to normal for a long time. The goal of losing weight is to make at least a lasting weight loss of 5% ~ 15%.
1, diet adjustment: control total calories and reduce fat intake. For those whose body mass index is 25 ≤ 30 mg/m2, a low-calorie diet of 1 200 kcal(502 1 kJ) per day is given to control the body weight within a suitable range.
2. Exercise: It is recommended to do 30 minutes of light to moderate intensity physical activities every day, such as cycling, sweeping the floor, walking and dancing.
3, diet drugs: such as sibutramine, can inhibit the reuptake of norepinephrine and serotonin, reduce food intake and lose weight. The routine dose is 5 ~ 15 mg per day. Orlistat can reduce fat absorption by inhibiting pancreatic lipase in gastrointestinal tract, each time 120mg, three times a day.
Relieve insulin resistance
Besides losing weight and exercising, metformin and thiazolidinediones (TZDS), agonists of peroxisome proliferator-activated receptor γ(PPARγ), are also commonly used to increase insulin sensitivity in clinic, but their mechanisms of action in treating metabolic syndrome are quite different:
1, the mechanism of action is different: TZDS acts on adipose tissue in metabolic syndrome, and reduces the free fat content by nearly 50% by reversing obesity. Metformin mainly acts on the liver and muscles. Metformin can significantly reduce liver glucose output and gluconeogenesis.
2. The influence of body weight is very different: Meta-analysis shows that TZD increases body weight by 4% ~ 6%, while metformin significantly reduces body weight. Moreover, the weight loss brought by metformin is more about the reduction of visceral fat. Studies have shown that after metformin treatment, total fat decreased by about 9%, subcutaneous fat decreased by 7%, and visceral fat decreased by as much as 15%.
The preventive effects on new-onset diabetes and cardiovascular events are also different: the data of large-scale clinical research confirmed that metformin intervention therapy can prevent new-onset diabetes (DPP study) and cardiovascular events (UKPDS study), but TZDS lacks clinical research results to confirm its similar effects.
Regulating blood lipid
Lipid-regulating therapy also plays an important role in metabolic syndrome. Common drugs are fibrates and statins (HMG-CoA reductase inhibitors):
1, Bates: Decrease TG, slightly to moderately decrease TC and LDL-C, and increase HDL-C. The commonly used drugs are fenofibrate, bezafib and gemfibrozil.
2. Statins: have a strong cholesterol-lowering effect, slightly reduce triglycerides and increase HDL-C effect. Commonly used drugs include atorvastatin, lovastatin, simvastatin, pravastatin and fluvastatin.
bring down the blood pressure
1. According to the report of the Seventh National Committee for Prevention, Monitoring, Evaluation and Treatment of Hypertension (JNC7), patients with systolic blood pressure ≥ 140mmHg/ diastolic blood pressure ≥90mmHg must be treated.
2. If the patient is complicated with diabetes, when the systolic blood pressure is ≥ 130mmHg/ diastolic blood pressure is ≥80mmHg, the antihypertensive treatment must be started.
Special instructions
Antihypertensive drugs should be selected without affecting sugar and fat metabolism:
1, the first choice: angiotensin converting enzyme inhibitor (ACEI) and/or angiotensin Ⅱ receptor antagonist (ARB) can increase insulin sensitivity. Commonly used drugs are captopril, enalapril, perindopril, ramipril, fosinopril and so on. , are used once a day. ARB preparations include Kosovo, Ambovine and Devine.
2. Calcium antagonists: long-acting ones should be selected. The commonly used drugs are amlodipine, felodipine and nifedipine controlled release tablets.
3. High-dose β -blockers and thiazide diuretics can affect glucose tolerance and increase insulin resistance, and increase TC and TG.