Identification and Management of Metabolic Syndrome: The Role of the APN

Douglas H. Sutton, EdD, MSN; Deborah A. Raines, PhD

Disclosures

Topics in Advanced Practice Nursing eJournal. 2007;7(2) 

In This Article

Goals of Clinical Management

For individuals diagnosed as having metabolic syndrome, first-line therapy is directed toward prevention and identification of major risk factors -- in other words, to manage[2]: atherogenic dyslipidemia, hypertension, and impaired glucose regulation.

Prevention of type 2 DM is another important goal for those individuals who do not yet have the disease because of the higher risk associated with type 2 DM and the development of atherosclerotic CVD. The emphasis for the clinician is to mitigate those risk factors that can be modified through therapeutic lifestyle changes (TLCs): obesity, physical inactivity, and atherogenic diet.

TLCs include:

  • Weight control;

  • Increased physical activity;

  • Alcohol moderation;

  • Sodium restriction; and

  • Emphasis on increased consumption of fresh fruits, vegetables, and low-fat dairy products.

TLCs positively affect each of the metabolic syndrome risk factors.[2]

Drug therapy remains a consideration for those individuals whose relative risk remains high in the presence of hypertension, dyslipidemia, or impaired glucose regulation. In addition, clinicians should remain ever attentive to bring about smoking cessation in any cigarette smokers.

The recommendations for clinical management are based largely on existing NHLBI, AHA, and the American Diabetes Association (ADA) guidelines for the management of specific risk factors. Lifestyle risk factor reduction focuses on long-term prevention of CVD and type 2 DM, whereas metabolic risk factor reduction focuses on shorter-term prevention of CVD and type 2 DM.

The therapeutic goals and recommendations related to lifestyle risk factor reduction, as presented in the AHA/NHLBI scientific statement, are as follows:

  • Balance activity and caloric intake to reduce baseline weight by 7% to 10% in the first year and, ultimately, to achieve an ideal body mass index (BMI) of less than 25 kg/m2;

  • Initiate regular, moderate-intensity physical activity of at least 30 minutes every day (desired), but at least 5 days per week; duration and intensity are based on the individual's relative risk;

  • Most dietary fat intake should be unsaturated; and

  • Dietary intake of simple sugars should be limited.

The therapeutic goals and recommendations related to metabolic risk factor reduction are presented in the AHA/NHLBI scientific statement, and are summarized in Table 2 .

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