Patient Care Endocrinology & Cardiology - October 2007 - (Page 11) Associated with an increased risk for type 2 diabetes mellitus and cardiovascular disease, the metabolic syndrome is mainly a result of the epidemic of overweight and obesity that is plaguing this and many other countries. Here is the information you need to better identify this condition and intervene effectively. most common definition in practice remains that of the ATP III (see Table 1, page 12). CASE CONTINUED Our patient met all of the following ATP III criteria for metabolic syndrome: increased waist circumference, elevated triglycerides, reduced HDL-C, impaired fasting glucose (IFG), and a history of hypertension, currently under treatment. An oral glucose tolerance test (OGTT) with a 75-g glucose load was done. Her fasting glucose was 105 mg/dL, and her 2-hour postload glucose was 169 mg/dL. Based on these results, she was diagnosed not only with IFG but with impaired glucose tolerance (IGT), or as having prediabetes and the metabolic syndrome. Note that, according to an American Diabetes Association (ADA) 2006 position statement, the relevant ranges for IFG are fasting glucose levels of 100 to 125 mg/dL (with a diagnosis of provisional DM, which must be confirmed, at levels above 125 mg/dL), and the relevant ranges for IGT are 2-hour postload glucose levels of 140 to 199 mg/dL (with a diagnosis of provisional DM, which must be confirmed, at levels above 200 mg/dL).7 CLINICAL SIGNIFICANCE About 47 million Americans have the metabolic syndrome. Its incidence in the US adult population is 24%, increases with age, and is highest in Mexican Americans (31.7%), followed by Caucasians (23.8%), African Americans (21.6%), and other ethnic groups (20.3%).8 The metabolic syndrome is a major public health challenge around the world that has been associated with a 3fold increase in type 2 DM and a 2-fold increase in CV disease (CVD).9 An unadjusted analysis of the ASCOT-BPLA (Anglo-Scandinavian Cardiac Outcomes Trial: Blood Pressure-Lowering Arm) showed that the metabolic syndrome was associated with a statistically significant in- OCTOBER 2007 PATIENT CARE ENDOCRINOLOGY & CARDIOLOGY 11
Table of Contents Feed for the Digital Edition of Patient Care Endocrinology & Cardiology - October 2007 Patient Care - Endocrinology & Cardiology - October 2007 Research Digest Contents Medicine in the News Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes Using Troponins to Evaluate Cardiac Injury The 15-Minute Visit Classified Advertising Clinical Clips Patient Care Endocrinology & Cardiology - October 2007 Patient Care Endocrinology & Cardiology - October 2007 - Patient Care - Endocrinology & Cardiology - October 2007 (Page Cover1) Patient Care Endocrinology & Cardiology - October 2007 - Patient Care - Endocrinology & Cardiology - October 2007 (Page Cover2) Patient Care Endocrinology & Cardiology - October 2007 - Patient Care - Endocrinology & Cardiology - October 2007 (Page 1) Patient Care Endocrinology & Cardiology - October 2007 - Research Digest (Page 2) Patient Care Endocrinology & Cardiology - October 2007 - Research Digest (Page 3) Patient Care Endocrinology & Cardiology - October 2007 - Research Digest (Page 4) Patient Care Endocrinology & Cardiology - October 2007 - Research Digest (Page 5) Patient Care Endocrinology & Cardiology - October 2007 - Research Digest (Page 6) Patient Care Endocrinology & Cardiology - October 2007 - Contents (Page 7) Patient Care Endocrinology & Cardiology - October 2007 - Contents (Page 8) Patient Care Endocrinology & Cardiology - October 2007 - Medicine in the News (Page 9) Patient Care Endocrinology & Cardiology - October 2007 - Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes (Page 10) Patient Care Endocrinology & Cardiology - October 2007 - Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes (Page 11) Patient Care Endocrinology & Cardiology - October 2007 - Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes (Page 12) Patient Care Endocrinology & Cardiology - October 2007 - Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes (Page 13) Patient Care Endocrinology & Cardiology - October 2007 - Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes (Page 14) Patient Care Endocrinology & Cardiology - October 2007 - Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes (Page 15) Patient Care Endocrinology & Cardiology - October 2007 - Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes (Page 16) Patient Care Endocrinology & Cardiology - October 2007 - Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes (Page 17) Patient Care Endocrinology & Cardiology - October 2007 - Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes (Page 18) Patient Care Endocrinology & Cardiology - October 2007 - Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes (Page 19) Patient Care Endocrinology & Cardiology - October 2007 - Using Troponins to Evaluate Cardiac Injury (Page 20) Patient Care Endocrinology & Cardiology - October 2007 - Using Troponins to Evaluate Cardiac Injury (Page 21) Patient Care Endocrinology & Cardiology - October 2007 - Using Troponins to Evaluate Cardiac Injury (Page 22) Patient Care Endocrinology & Cardiology - October 2007 - Using Troponins to Evaluate Cardiac Injury (Page 23) Patient Care Endocrinology & Cardiology - October 2007 - Using Troponins to Evaluate Cardiac Injury (Page 24) Patient Care Endocrinology & Cardiology - October 2007 - Using Troponins to Evaluate Cardiac Injury (Page 25) Patient Care Endocrinology & Cardiology - October 2007 - The 15-Minute Visit (Page 26) Patient Care Endocrinology & Cardiology - October 2007 - Classified Advertising (Page 27) Patient Care Endocrinology & Cardiology - October 2007 - Clinical Clips (Page 28) Patient Care Endocrinology & Cardiology - October 2007 - Clinical Clips (Page Cover3) Patient Care Endocrinology & Cardiology - October 2007 - Clinical Clips (Page Cover4)
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