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Some medical experts contend that metabolic syndrome is a harbinger ofincreased morbidity and mortality—and that publicizing it is animportant way to educate patients about the links between their lifestyle,health risks, and medical outcomes.
Others suggest that metabolic syndrome is an elusive and poorly definedconcept of limited value in the clinical setting. Recently, the AmericanDiabetes Association and the European Association for the Study of Diabetespublished a joint statement suggesting that metabolic syndrome isn't really asyndrome and should not be a diagnosis used in primarycare1(DOC News, October 2005).
DOC News asked:
Does the presence of metabolic syndrome show a greater risk for heartdisease than the sum of its component risks? What is the value in primary carepractice of diagnosing patients with metabolic syndrome?
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I may be just a lowly RN diabetes educator who doesn't even have a CDE yet,but isn't metabolic syndrome the same thing as pre-diabetes? So, yes, I thinkall the damage-causing symptoms of pre-diabetes, like low HDLs, high bloodpressure, abdominal adiposity, and insulin resistance, merit its being treatedas one syndrome. Why not just call it all type 2 diabetes? If it walks like aduck....
It's a shame that people have to wait until their diabetes has gotten tothe point where their blood glucose goes above 200 [mg/dl] after meals, theirarteries are clogging up, toes are going numb, and heart muscle is starvingbefore it is called by its rightful name and can be treated as such.
My mentor, Carol, who handed down to me the issue of DOC News thatI'm responding to, also had some comments: "You have a disease thataffects the whole body, and you're quibbling over names. It just gives me aheadache."
Richard Featherly, RN
Diabetes Educator
Hancock, Mich.
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The diagnosis is very useful. There are so many risk factors associatedwith metabolic syndrome. If you can recognize any of these risk factors andmake an impact on the patient, you're going to affect their quality of lifeand ultimately their survival.
William Kaplan, MD
Family Medicine
San Francisco, Calif.
We could define each risk factor independently as we always have done.Patients would be told that they have high blood pressure, high cholesterol,that they are obese, and that they have coronary artery disease, and then gettreated and counseled for these individual conditions.
However, the metabolic syndrome has a much more powerful message—ittakes a cluster of symptoms and signs, puts it under one roof, and permits theclinician to use it as a major power player to tell his/her patient that theyare getting into serious trouble.
Further, since the treatment for most, if not all, of the independentdiseases described are treated in an identical fashion and patients arecounseled the same way, it makes much more sense to put the risk factors underone roof and repair the roof. Sometimes physicians will look at someone whosewaist is a little big and say to the patient, "Go ahead, lose a littlebit of weight." Perhaps the blood pressure is 135/88 [mmHg] and doesn'traise much of an eyebrow or is totally overlooked by the physician. Themetabolic syndrome description puts these together and creates a more alarmingsituation for both physicians and patients.
The value in primary care practice of diagnosing patients with metabolicsyndrome is prevention before there is any overt illness.
Dennis Gage, MD
Endocrinology
Lenox Hill Hospital
New York,N.Y.
Metabolic syndrome is a constellation of well-known risk factors forcardiac disease and possibly diabetes. It isn't useful as a diagnosis inprimary care because it makes it sound like a whole other disease state, andin fact it isn't. It's a state of health that puts these people at risk. Itmay be helpful to the patient, but if you give them a diagnosis they'll goonline and look for a support group for metabolic syndrome.
It's a misleading concept. What happens if you have syndrome X? Your firstheart attack, first stroke, the development of diabetes. You get anotherdiagnosis.
Laura Loesel, MD
Family Medicine
Chicago, Ill.
From my perspective, it's been only in the last 18–24 months thatI've become so aware of metabolic syndrome. We in family practice should treatthe whole patient anyway, looking at all the organs and systems together atone time. [We should] not just treat hypertension or hyperlipidemia, but usecombination therapy that will be beneficial for most systems.
Ronald Edwards, MD
Family Medicine
Arma, Kan.
Metabolic syndrome encompasses a lot of diseases—hypertension,diabetes, morbid obesity. It's really a diagnosis where people have a tendencyto become ill and die early. With the diagnosis, you at least know what to do,what the related illnesses are, so you can home in on it, particularly infamily practice, where you're very busy.
If you have this diagnosis of metabolic syndrome, you already know what youhave to do—take care of the blood pressure, take care of the bloodsugar, and take care of the weight. So there's no going around andrediscovering things.
Custodio Garrido, MD
Family Medicine
Huntington, Ind.
TALK BACK: CHEESEBURGER JUSTICE
The U.S. House of Representatives in October passed a so-calledcheeseburger bill that would ban lawsuits accusing restaurants and foodmanufacturers of making peoplefat.
Only a few such cases have been filed. One closely watched lawsuit againstMcDonald's Corp. was filed in 2002, alleging deceptive advertising practicesto entice children to eat unhealthy food. The case, twice tossed out of aManhattan federal court, was resuscitated upon appeal and is back before U.S.District Judge Robert Sweet. In October, Sweet asked the plaintiffs for morespecific information to bolster their claim that McDonald's food makeschildren fat. He says the plaintiffs need to show how eating Happy Meals andBig Macs caused their injuries.
McDonald's has separately announced that it will begin printing nutritionalinformation including calories and grams of fat, protein, carbohydrates, andsodium on food packaging in 20,000 of its 30,000 restaurants by the end of2006.
What do you think? Could food-related lawsuits help stem the tide of thegrowing obesity epidemic, or is it a matter of personalresponsibility?
Send your comments todocnews{at}diabetes.org.
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