Summary of prevention and control
Because every component of metabolic syndrome is a risk factor of cardiovascular disease, their combined effect is stronger, so some people call metabolic syndrome "death quartet" (central obesity, hyperglycemia, hypertriglyceridemia and hypertension). Therefore, metabolic syndrome is a general and economical concept of 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 control of blood sugar; Improve lipid metabolism disorder and control blood pressure.
lose weight
Any obese patient with diabetes needs to lose weight. Mainly through diet and lifestyle changes and necessary drugs. Studies have shown that it is less likely to make obese people lose weight to normal for a long time. The goal of losing weight is to reduce the body weight by at least 5% ~15% permanently.
1, diet regulation: control the total calories and reduce fat intake. For those with a BMI of 25 ≤ 30 mg/m2, a low-calorie diet of 1200kcal(502 1 kilojoule) per day was given to control the body weight in a suitable range.
2. Exercise: It is recommended to carry out light to moderate intensity physical activities for 30 minutes every day, such as riding a bike, cleaning the floor, walking and dancing.
3, weight-loss drugs: such as sibutramine, can inhibit the reuptake of norepinephrine and serotonin, reduce food intake and lose weight. The routine dosage is 5 ~15 mg per day. Orlistat can reduce fat absorption by inhibiting pancreatic lipase in gastrointestinal tract, once 120mg, three times a day.
Alleviate insulin resistance
In addition to weight loss and exercise, metformin and thiazolidinediones (TZDS), agonists of peroxisome proliferator-activated receptor γ(PPARγ), are commonly used in clinic to increase insulin sensitivity, 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, which 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% after use, while metformin significantly reduces body weight. Moreover, the weight loss caused by metformin is more the reduction of visceral fat. Studies have shown that after metformin treatment, the total fat decreased by about 9%, the subcutaneous fat decreased by 7%, and the 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 studies confirm 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.
Adjust blood lipid
Lipid-regulating therapy also plays an important role in metabolic syndrome. The common drugs are fibrates and statins (HMG-CoA reductase inhibitors):
1, fibrates: reduce TG, while slightly to moderately reduce TC and LDL-C, and increase HDL-C. Commonly used drugs are fenofibrate, phenZabyti and gemfibrozil.
2. Statins: have strong cholesterol lowering effect, slightly lower TG 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 7th National Committee on 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, antihypertensive treatment must be started when systolic blood pressure is ≥ 130mmHg/ diastolic blood pressure is ≥80mmHg.
special explanation
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), which can increase insulin sensitivity. Commonly used drugs are captopril, enalapril, perindopril, ramipril, fosinopril, etc., all of which are used once a day. ARB preparations include Kosova, Ambovine and Devine.
2. Calcium antagonists: long-acting ones should be selected. Commonly used drugs are amlodipine, felodipine and nifedipine controlled release tablets.
3. Large doses of β -blockers and thiazide diuretics can affect glucose tolerance and increase insulin resistance, and increase TC and TG.