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Title: ... statistics from the American Diabetes Association an


1
Cardiometabolic Risk Evaluation Treatment in
Your Patient Population
--Insert Here Speaker Title and Affiliation
2
Why Focus on Cardiometabolic Risk?
  • A comprehensive approach to patient care
    Multiple disease pathways and risk factors are
    considered to facilitate earlier intervention
  • Early assessment and targeted intervention are
    needed to treat and prevent all risk factors
    associated with CVD and diabetes

3
Cardiometabolic Risk
  • Gives a comprehensive picture of a patients
    health and potential risk for future disease and
    complications
  • Is inclusive of all risks related to metabolic
    changes associated with CVD
  • Accommodates emerging risk factors as useful
    predictive tools
  • Focuses clinical attention to the value of
    systematic evaluation, education, disease
    prevention and treatment
  • Supports an integrated approach to care

Kahn, et al. The Metabolic Syndrome Time for a
Critical Appraisal Joint Statement From the
American Diabetes Association and the European
Association for the Study of Diabetes Diabetes
Care. 200528 (9)2289-2304.
4
The State of Risk
  • 2 out of 3 Americans are overweight or obese
  • More than 70 million (nearly 1 in 4) Americans
    have varying degrees of insulin resistance
  • There are an estimated 54 million (more than 1 in
    6) Americans with prediabetes
  • Nearly 1 in 4 U.S. adults has high cholesterol
  • 1 in 3 American adults has high blood pressure

5
Direct and Indirect Cost of CVD and Diabetes
Estimated Indirect Costs (disability, work loss,
premature mortality)
Estimated Direct Medical Costs
Note these figures may not account for
potential overlap. Sources 2008 statistics from
the American Diabetes Association and American
Heart Association.
6
Cardiometabolic Risk - Graphic
Overweight / Obesity
Abnormal Lipid Metabolism LDL ? ApoB ? HDL
? Trigly. ?
Cardiometabolic Risk Global Diabetes / CVD Risk
Smoking Physical Inactivity Unhealthy Eating
Inflammation Hypercoagulation
Hypertension
7
Non-modifiable
Cardiometabolic Risk Factors
Modifiable
  • Age
  • Race/ethnicity
  • Gender
  • Family history
  • Overweight
  • Abnormal lipid metabolism
  • Inflammation, hypercoagulation
  • Hypertension
  • Smoking
  • Physical inactivity
  • Unhealthy diet
  • Insulin resistance

8
Case - Mr. Martin
  • 47-year-old African American man, hasnt seen
    doctor in years
  • Works as a truck driver, eats mostly fast food
  • Smokes 1 pack per day
  • At health fair found to have BP 146/86, total
    cholesterol 210
  • Weight 230 lbs BMI 29 kg/m²
  • Family history of HTN and diabetes

9
Whats Mr. Martins Cardiometabolic Risk?
  • Age 47
  • Race/ethnicity African American
  • Gender Male
  • Family history HTN and diabetes
  • Overweight/obesity BMI 29
  • Abnormal lipid metab TC 210
  • Hypertension BP 146/86
  • Smoking 1 pack per day
  • Physical Inactivity Yes
  • Unhealthy diet Fast food diet

10
Non-ModifiableRisk Factors
11
Est. New Diabetes Diagnoses by Age, 2005
Number
40-59
60
20-39
Age Group
Centers for Disease Control and Prevention.
National diabetes fact sheet general information
and national estimates on diabetes in the United
States, 2005. Atlanta, GA U.S. Department of
Health and Human Services, Centers for Disease
Control and Prevention, 2005.
12
Cardiovascular Risk Factor Trends Among U.S.
Adults Aged 20-74
39.2
30.8
36.0
33.6
33.1
1960-1962
28.2
29.3
1971-1975
27.2
26.3
26.4
1976-1980
1988-1994
19.0
1999-2000
14.8
17.0
14.9
5.0
4.6
3.5
3.4
1.8
High Blood Pressure
High Total Cholesterol
Diagnosed Diabetes
Smoking
Centers for Disease Control Prevention,
Division for Heart Disease and Stroke Prevention,
"Addressing the Nation's Leading Killers At A
Glance 2007
13
American Indians/ Alaska Natives
Non-Hispanic Blacks
Hispanic/Latino Americans
Non-Hispanic Whites
0
6
4
2
12
8
10
20
14
16
18
Centers for Disease Control and Prevention.
National diabetes fact sheet general information
and national estimates on diabetes in the United
States, 2005. Atlanta, GA U.S. Department of
Health and Human Services, Centers for Disease
Control and Prevention, 2005.
14
Insulin Resistance
15
Factors affectinginsulin resistance
  • Overweight/ fat distribution
  • Age
  • Genetic predisposition
  • Activity level
  • Medications
  • Puberty
  • Pregnancy

16
IFG and IGT
  • Impaired Fasting Glucose (IFG) a condition in
    which the blood glucose level is between 100
    mg/dL to 125mg/dL after an 8- to 12-hour fast.
  • Impaired Glucose Tolerance (IGT) a condition in
    which the blood glucose level is between 140 and
    199 mg/dL at 2 hours during an oral glucose
    tolerance test (OGTT).

17
Interpreting BloodGlucose Levels
  • Healthy BG FPG lt 100 mg/dL
  • Pre-diabetes FPG 100125 mg/dL
  • Diabetes FPG 126 mg/dL

18
Criteria for testing for type 2 diabetesin
asymptomatic children50
  • Overweight (BMI gt 85th percentile for age and
    sex, weight for height gt 85th percentile, or
    weight
  • gt120 percent of ideal for height) Plus any two of
    the following
  • Family history
  • Race/ethnicity
  • Signs of insulin resistance or conditions
    associated with insulin resistance
  • Maternal history of diabetes or GDM

19
Criteria for testing for diabetes in asymptomatic
adult individuals50
  • Testing should be considered in all overweight
    adults
  • (BMI 25 kg/m2) and have additional risk
    factors
  • Physical inactivity
  • First-degree relative with diabetes
  • Members of a high-risk ethnic population
  • Women delivering baby weighing gt9 lb or
    were diagnosed with GDM
  • Hypertension (140/90 mmHg)

Continued
20
Criteria for testing for diabetes in asymptomatic
adult individuals50
  • HDL cholesterol level lt35 mg/dl (0.90 mmol/l)
    and/or a triglyceride level gt250 mg/dl (2.82
    mmol/l)
  • Women with polycystic ovarian syndrome (PCOS)
  • IGT or IFG on previous testing
  • Other clinical conditions associated with insulin
    resistance (e.g., severe obesity and acanthosis
    nigricans)
  • History of CVD

21
Criteria for testing for diabetes in asymptomatic
adult individuals50
  • 2. In the absence of the above criteria, testing
    for pre-diabetes and diabetes should begin at age
    45 years
  • 3. If results are normal, testing should be
    repeated at least at 3-year intervals, with
    consideration of more frequent testing depending
    on initial results and risk status.
  • At-risk BMI may be lower in some ethnic
    groups.

22
Insulin Resistance and CHD Mortality Paris
Prospective Study
(n943)
3
Plt.01
2
CHD mortality, per 1000
1
0
?29 30-50 51-72 73-114
?115
Quintiles (pmol) of fasting plasma insulin
Insulin Sensitive Insulin Resistant
Fontbonne AM, et al. Diabetes Care.
199114461-469.
23
Proposed Metabolic Observations in the Natural
History of Type 2 Diabetes
Insulin Sensitivity
Insulin Secretion
Associated Risk Factors
  • Hypertension
  • Dyslipidemia

Atherogenesis
Microvascular
Complications
Fasting Blood Glucose
Type 2 Diabetes
Age (years)
24
Overweight/Obesity
25
Understanding Cardiometabolic Risk Broadening
Risk Assessment and Management
26
Screening Overweight
  • Measure BMI routinely at each regular check-up.
  • Classifications
  • BMI 18.5-24.9 normal
  • BMI 25-29.9 overweight
  • BMI 30-39.9 obesity
  • BMI 40 extreme obesity

Clinical Guidelines on the Identification,
Evaluation, and Treatment of Overweight and
Obesity in Adults The Evidence Report. NIH
Publication 98-4083, September 1998, National
Institutes of Health.
27
Measuring Waist Circumference
  • Large waist circumference (WC) can identify some
    at increased risk over BMI alone
  • If BMI and other cardiometabolic risk factors are
    assessed, currently there is insufficient
    evidence to
  • Substitute WC for BMI
  • Measure WC in addition to BMI

Klein, et al. Waist Circumference and
Cardiometabolic Risk. Diabetes Care. 2007 0
dc07-9921v1-0.
28
Multiple Factors Associated With Obesity Give
Rise to Increased Risk of CVD
Primary Metabolic Disturbance
Intermediate Vascular Disease Risk Factor
Intravascular Pathology
Clinical Event
Overnutrition
CVD
Despres JP, et al. Abdominal obesity and
metabolic syndrome. Nature. 2006444881-887.
29
Body Weight and CVD
Men
Women
300
267
250
200
200
Incidence of CVD per 1,000
128
150
125
121
105
100
50
0
lt100 110-129 130 lt110 110-129 130
n56 n75 n30 n191 n199 n78
Metropolitan Relative Weight percent
(percentage of desirable weight)
Hubert HB et al. Circulation. 198367968-977
30
Risk ManagementOverweight
  • Lifestyle modification
  • Reduce caloric intake by 500-1000 kcal/day
    (depending on starting weight)
  • Target 1-2 pound/week weight loss
  • Increase physical activity
  • Healthy diet
  • Diabetes Prevention Program
  • DASH diet

Clinical Guidelines on the Identification,
Evaluation, and Treatment of Overweight and
Obesity in Adults The Evidence Report. NIH
Publication 98-4083, September 1998, National
Institutes of Health. Diabetes Prevention
Program (DPP) Diabetes Care 2521652171, 2002.
The Seventh Report of the Joint National
Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure, NIH
Publication No. 04-5230, August 2004
31
Risk Management, cont. Overweight
  • Consider pharmacologic treatment
  • BMI ?30 with no related risk factors or diseases,
    or
  • BMI ?27 with related risk factors or diseases
  • As part of a comprehensive weight loss program
    incl. diet physical activity
  • Consider surgery
  • BMI ?40 or
  • BMI ?35 with comorbid conditions

Clinical Guidelines on the Identification,
Evaluation, and Treatment of Overweight and
Obesity in Adults The Evidence Report. NIH
Publication 98-4083, September 1998, National
Institutes of Health. Diabetes Prevention
Program (DPP) Diabetes Care 2521652171, 2002
32
Abnormal Lipid Metabolism
33
Total Cholesterol Goals34
  • Desirable Less than 200 mg/dL
  • Borderline high risk 200239 mg/dL
  • High risk 240 mg/dL and over

American Diabetes Association. Understanding
Cardiometabolic Risk Broadening Risk Assessment
and Management, Dyslipidemia Richard M
Bergenstal, MD International Diabetes Center
34
Abnormal Lipid Metabolism
  • Increased
  • Triglycerides
  • VLDL
  • LDL and small dense LDL
  • ApoB
  • Decreased
  • HDL
  • Apo A-I

American Diabetes Association. Diabetes Care.
200730S4-41.
35
Major Risk FactorsAffecting Lipid Goals36
  • Cigarette smoking
  • Hypertension (140/90 mm Hg or on
    antihypertensive medication)
  • Low HDL-C (lt40 mg/dL)
  • Family history of early heart disease
  • Age (men 45 years women 55 years)

36
  • Statins (also called HMG-CoA reductase
    inhibitors) work by increasing hepatic LDL-C
    removal from the blood.
  • Resins (also called bile acid sequestrants) bind
    to bile acids in the intestines and prevent their
    reabsorption, leading to increased hepatic LDL-C
    removal from the blood.
  • Cholesterol absorption inhibitors help lower
    LDL-C by reducing the amount of cholesterol
    absorbed in the intestines increases LDL
    receptor activity.

37
  • Fibrates (also called fibric acid derivatives)
    activate an enzyme that speeds the breakdown of
    triglyceriderich lipoproteins while also
    increasing HDL-C.
  • Niacin (also called nicotinic acid) reduces the
    livers ability to produce VLDL. When given at
    high doses, it can also increase HDL-C.

American Diabetes Association. Understanding
Cardiometabolic risk Broadening risk Assessment
and Management, Dyslipidemia Richard M
Bergenstal, MD International Diabetes Center
38
Cholesterol Management
  • For patients gt20 years of age, cholesterol should
    be checked every 5 years
  • Ordering a fasting lipid panel is preferred to
    gauge the patients total cholesterol, LDL-C,
    HDL-C and triglycerides
  • Treatment priorities

39
Cholesterol Management
LDL-C-lowering
40
Cholesterol Management
  • Improve glucose control if diabetes is present
  • Weight loss if overweight
  • Daily exercise
  • Smoking cessation
  • Dietary modifications including low saturated fat
    (fat intake less than 30 of total calories and
    saturated fat less than 7 of total calories),
    low cholesterol (no more than 200 mg daily) diet
  • Pharmacologic treatment frequently necessary
  • Risk factors include hypertension HDL lt 40
    family history of MI before age 55 male gt 45
    years old female gt 55 years old smoking.

41
Risk of CHD by Triglyceride LevelThe Framingham
Heart Study
3
Women
Men
2.5
n5,127
2
1.5
Relative Risk
1
0.5
0
50
100
150
200
250
300
350
400
Triglyceride Level, mg/dL
Castelli WP. Epidemiology of triglycerides a
view from Framingham American Journal of
Cardiology. 1992703H-9H.
42
Association Between Small, Dense LDL and Insulin
Resistance
12
(n19)
10
(n29)
8
(n52)
Mean Steady State Plasma Glucose (mmol/L) at
Identical Plasma Insulin
6
4
2
0
A Larger LDL particle pattern
B Small LDL particle pattern
Intermediate pattern
LDL-Size Phenotype
Reaven GM, et al. J Clin Invest. 199392141-146.
43
Low HDL-C Independent Predictor of CHD Risk,
Even When LDL-C is Low
Risk of CHD
HDL-C (mg/dL)
LDL-C (mg/dL)
Gordon T, Castelli WP, Hjortland MC, Kannel WB,
Dawber TR. High density lipoprotein as a
protective factor against coronary heart disease.
The Framingham Study. American Journal of
Medicine. 197762707-14.
.
44
Screening for Dyslipidemia
  • Persons without Diabetes
  • Test at least every 5 years, starting at age 20,
    including adults with low-risk values
  • Persons with Diabetes
  • In adults, test at least annually
  • Lipoproteins measure at after initial blood
    glucose control is achieved as hyperglycemia may
    alter results

Preventing Cancer, Cardiovascular Disease, and
Diabetes A Common Agenda for The American Cancer
Society, the American Diabetes Association, and
the American Heart Association. Circulation.
20041093244-3255. American Diabetes
Association. Standards of Medical Care in
Diabetes 2007. Available at http//care.diabetesj
ournals.org/cgi/reprint/30/suppl_1/S4
45
Healthy Lipid GoalsTargets for Patients Without
DM or CVD

Third Report of the National Cholesterol
Education Program (NCEP) Expert Panel on
Detection, Evaluation, and Treatment of High
Blood Cholesterol in Adults (Adult Treatment
Panel III) National Cholesterol Education
Program, National Heart, Lung, and Blood
Institute, National Institutes of Health. NIH
Publication No. 01-3670, May 2001
46
Risk ManagementAbnormal Lipids
  • Lifestyle modification
  • Increased physical activity
  • Diet reduced saturated fat, trans fat, and
    cholesterol
  • Weight loss, if indicated

American Diabetes Association. Diabetes Care.
200730S4-41.
47
Risk ManagementAbnormal Lipids
  • Pharmacologic treatment primary goal is LDL
    lowering
  • Without overt CVD If over 40, statin therapy
    recommended to achieve 30-40 LDL reduction
  • With overt CVD All patients should receive
    statin therapy to achieve 30-40 LDL reduction
  • Lowering triglycerides and raising HDL with a
    fibrate is associated with fewer cardiovascular
    events in patients with clinical CVD, low HDL,
    and near-normal LDL

American Diabetes Association. Diabetes Care.
200730S4-41.
48
Hypertension
49
Hypertension Evaluation and Screening
  • Persons without Diabetes
  • BP should be measured at each regular visit or at
    least once every 2 years if BP lt120/80 mmHg
  • BP measured seated after 5 min rest in office
  • Persons with Diabetes
  • BP should be measured at each regular visit
  • BP measured seated after 5 min rest in office
  • Patients with 130 or 80 mmHg should have BP
    confirmed on a separate day

Preventing Cancer, Cardiovascular Disease, and
Diabetes A Common Agenda for the American Cancer
Society, the American Diabetes Association, and
the American Heart Association. Circulation.
20041093244-3255. American Diabetes
Association. Diabetes Care. 200730S4-41.
50
Management of Hypertension
  • Non-pharmacologic
  • DASH diet
  • Dietary Approaches to Stop Hypertension
  • High in whole grains, fruits, vegetables, and
    low-fat dairy
  • Low in saturated and trans fat, cholesterol
  • Physical Activity
  • Weight loss, if applicable

The Dash Diet. http//dashdiet.org. American
Diabetes Association. Diabetes Care.
200730S4-41.
51
Management of Hypertension
  • Pharmacologic
  • Drug therapy indicated if BP 140/ 90 mm Hg
  • Combination therapy often necessary
  • Treatment should include ACE or ARB
  • Thiazide diuretic may be added to reach goals
  • Monitor renal function and serum potassium

The Dash Diet. http//dashdiet.org. American
Diabetes Association. Diabetes Care.
200730S4-41.
52
Complications of Hypertension in Patients with
Diabetes
  • Microvascular
  • Renal disease
  • Autonomic neuropathy
  • Eye disease (glaucoma, retinopathy with
    potential blindness)
  • Macrovascular
  • Cardiac disease
  • Cerebrovascular disease
  • Reduced survival and recovery rates from stroke
  • Peripheral vascular disease

American Diabetes Association. Diabetes Care.
200730S4-41..
53
Physical Inactivity
54
Physical Activity
  • 35 of coronary heart disease deaths in the US
    can be attributed to an inactive lifestyle
  • Consistent exercise can reduce CVD risk
  • Exercise, combined with healthy diet and weight
    loss, is proven to prevent/delay onset of type 2
    diabetes?

American Diabetes Association. Diabetes Care.
200730S4-41. ? Diabetes Prevention Program
Diabetes Care 2521652171, 2002.
55
Physical Activity
  • Guidelines
  • Fit into daily routine
  • Aim for at least 150 minutes/week of moderate
    aerobic exercise
  • Start slowly and gradually build intensity
  • Wear a pedometer (10,000 steps)
  • Encourage patients to take stairs, park further
    away or walk to another bus stop, etc.

American Diabetes Association. Diabetes Care.
200730S4-41.
56
Physical Activity
  • Benefits of Exercise
  • Increased insulin sensitivity
  • Improved lipid levels
  • Lower blood pressure
  • Weight control
  • Improved blood glucose control
  • Reduced risk of CVD
  • Prevent/delay onset of type 2 diabetes

American Diabetes Association. Diabetes Care.
200730S4-41.
57
Exercise Precautions Related to Complications of
Diabetes
  • Peripheral neuropathy can cause loss of sensation
    in feet educate about preventive care measures
    for foot protection
  • Pre-existing CVD can cause arrhythmias,
    myocardial ischemia, or infarction during
    exercise
  • In presence of PDR or severe NPDR, vigorous
    exercise or resistance training may be
    contraindicated because of risk of vitreous
    hemorrhage or retinal detachment

American Diabetes Association. Diabetes Care.
200730S4-41.
58
Smoking
59
Impact of Baseline Smoking on MI in Type 2
Diabetes UKPDS
Hazards Ratio (95 CI) Never Smoked 1 Ex-Smoker
1.08 (0.75 - 1.54) Current Smoker 1.58 (1.11
- 2.25)
R C Turner, H Millns, H A W Neil, I M Stratton, S
E Manley, D R Matthews, and R R Holman. Risk
factors for coronary artery disease in
non-insulin dependent diabetes mellitus United
Kingdom prospective diabetes study (UKPDS 23)
BMJ. 1998316823-828.
60
Smoking Screening and Intervention
  • Obtain documentation of history of tobacco use
  • Ask whether smoker is willing to quit
  • If no, initiate brief, motivational discussion
    regarding
  • the need to stop using tobacco
  • risks of continued use
  • encouragement to quit, as well as support when
    ready
  • If yes, assess preference for and initiate either
    minimal, brief, or intensive cessation
    counseling.

American Diabetes Association. Diabetes Care.
200427S27S74-S75.
61
Provide Smoking Cessation Resources
  • Set a Plan
  • Offer counseling and referrals
  • Offer medication assistance
  • Offer combined pharmacologic and behavioral
    intervention
  • Online guide to quitting SmokeFree.gov

American Diabetes Association. Diabetes Care.
200427S27S74-S75.
62
Inflammation
63
Inflammation / Hypercoagulation
  • Proinflammatory/prothrombotic factors underlie
    cardiometabolic risk
  • Inflammation is a major component of
    atherogenesis and other cardiometabolic problems
  • Obesity is associated with inflammation

Ross R. Atherosclerosis an inflammatory disease.
N Engl J Med. 1999340115-126. Ballantyne CH,
Nambi V. Markers of inflammation and their
clinical significance. Atherosclerosis suppl
2005 6 21-9. McLaughlin T et al.
Differentiation between obesity and insulin
resistance in the association with C-reactive
protein. Circulation. 20021062908-2912.
64
Risk Management Inflammation
  • High-sensitivity CRP tests may be used to further
    evaluate underlying risk
  • Relative risk categories
  • Low risk lt1 mg/L
  • Average risk 1-3 mg/L
  • High risk gt3 mg/L
  • Aspirin and statins reduce CRP levels
  • Unclear whether CRP should be a treatment target
  • Reduce weight

Ross R. Atherosclerosis an inflammatory disease.
N Engl J Med.1999340115- 126. Ballantyne CH.
65
Pre-Diabetes and Diabetes Prevention
66
Pre-Diabetes
  • Pre-diabetes is an important risk factor for
    future diabetes and cardiovascular disease
  • Recent studies have shown that lifestyle
    modification can reduce the rate of progression
    from pre-diabetes to diabetes

American Diabetes Association, Diabetes Care.
200730S4-41..
67
Glucose Tolerance Categories
Any abnormality must be repeated and confirmed on
a separate day
Fasting Plasma Glucose
2-hour Plasma Glucose On OGTT
Diabetes Mellitus
Diabetes Mellitus
126 mg/dL
200 mg/dL
Impaired Glucose
Impaired Fasting
Tolerance
Glucose
100 mg/dL
140 mg/dL
Normal
Normal
Pre-Diabetes
One can also make the diagnosis of diabetes
based on unequivocal symptoms and a random
glucose gt200 mg/dL
Adapted from The Expert Committee on the
Diagnosis and Classification of Diabetes
Mellitus. Diabetes Care 2004 Supplement 1
68
ADA Consensus Conference on IFG and IGT
Implications for Diabetes Care October 16-18,
2006
  • Results
  • Treat IFG and IGT with aggressive lifestyle
    modification
  • For certain patients with both IFG and IGT
    consider metformin

Nathan D, et al. Impaired Fasting Glucose and
Impaired Glucose Tolerance Implications for
Care. Diabetes Care. 2007 30 753-759.
69
40
Placebo
30
Metformin
Cumulative Incidenceof Diabetes ()
20
Lifestyle
10
0
0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Years
Knowler WC, et al. NEJM. 2002346393-403.
70
Results of Recent Randomized Trials
Behavior
Medication
71
Goals for Glycemic Control
For non-pregnant individuals As close to
normal (lt6) as possible without significant
hypoglycemia
American Diabetes Association. Diabetes Care.
200730S4-41..
72
Screening For Diabetes
  • Fasting plasma glucose at least every 3 yrs
    starting at age 45
  • Consider at younger age, or more frequently, if
    patient is overweight and has one or more of the
    following risk factors (or two if not
    overweight)
  • Family history of diabetes
  • Overweight (BMI 25 kg/m2)
  • Habitual physical inactivity

  • (continued)

American Diabetes Association. Diabetes Care.
200730S4-41..
73
Screening For Diabetes
  • Additional risk factors
  • Race/ethnicity (e.g., African-Americans,
    Hispanic-Americans, Native Americans,
    Asian-Americans, and Pacific Islanders)
  • Previously identified IFG or IGT
  • Hypertension (140/90 mmHg in adults)
  • HDL cholesterol (35 mg/dl 0.90 mmol/l and/or a
    triglyceride level 250 mg/dl 2.82 mmol/l)
  • History of GDM or delivering baby weighing gt9 lbs
  • Polycystic ovary syndrome (PCOS)

American Diabetes Association. Diabetes Care.
200730S4-41..
74
  • Age 47
  • Race/ethnicity African American
  • Gender Male
  • Family history HTN and diabetes
  • Overweight/obesity BMI 29
  • Abnormal lipid metab TC 210
  • Hypertension BP 146/86
  • Smoking 1 pack per day
  • Physical Inactivity Sedentary
  • Unhealthy diet Fast food diet

75
  • Identify at-risk patients by evaluating a
    spectrum of predisposing risk factors
  • The existence of any one risk factor is an alert
    to evaluate patient for others
  • Integrate evidence-based risk management
    strategies to target modifiable risk factors

Kahn, et al. The Metabolic Syndrome Time for a
Critical Appraisal Joint Statement From the
American Diabetes Association and the European
Association for the Study of Diabetes. Diabetes
Care. 200528 (9)2289-2304.
76
What Should We Do?
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