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Who, and When, Should We Screen for Metabolic Risk?

Sep 28, 2019
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Keri Hames, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences

Updated guidelines on how best to screen for metabolic risk to help with the prevention of both type 2 diabetes and ASCVD.

Patients between 40 to 75 years of age should be screened for the five components of metabolic risk, according to updated clinical practice guidelines issued by the Endocrine Society. The following measurements should be taken: LDL-C, triglycerides, blood pressure, waist circumference, and blood glucose levels.  These measurements should be taken when patients have clinical visits or annual physicals. The purpose of physicians screening for this information is to detect early diagnosis of atherosclerotic cardiovascular disease (ASCVD) and/or type 2 diabetes. 

 

If a patient is discovered to have three or more of the above components (i.e., LDL-C, triglycerides, blood pressure, waist circumference, and blood glucose levels) they are known to have an increased metabolic risk, also known as metabolic syndrome.  For these patients, they should have a 10-year ASCVD risk assessment done to determine the goal of therapy for the reduction of LDL-C, according to current guidelines. It is important to determine patients’ metabolic risk so that we can help prevent both ASCVD and type 2 diabetes. The reason for knowing patients’ metabolic risk is to start the appropriate medications to prevent the progression of these diseases.

Current guidelines have addressed patients that have metabolic syndrome yet have not been diagnosed with ASCVD or type 2 diabetes and what steps they can take to prevent these outcomes from occurring.  The guidelines state that these patients should focus on the management of nutrition, behavior, and medical options. Medications should be added to patients where lifestyle modifications have not worked, and goals have not been met.

Patients that have metabolic syndrome should be screened regularly for ASCVD and type 2 diabetes, whereas patients that have one or two risk factors should be screened every three years and patients with prediabetes screened yearly. These risk factors should also include CVD risk factors such as smoking, family history, and cholesterol levels.  The guidelines focus on patients that are between the ages of 40 and 75 years but can be applied to patients that are not within this age group.

The guidelines also recommend that lifestyle modifications should be prescribed first before medication in patients that are pre-diabetic and that lifestyle modifications are the first line of therapy in patients with metabolic syndrome. The guidelines also state that patients that have excess weight should aim to lose 5% or more of their initial body weight.  Finally, the guidelines state that patients should undergo an assessment of their 10-year ASCVD risk to know if medication is needed, blood pressure should be checked annually (i.e., if elevated should be checked at every office visit), and the measuring of a patient’s waist circumference should be part of clinical examinations. 

Practice Pearls:

  • Patients between the age of 40 to 75 should be screened for the components of metabolic syndrome.
  • The determination of metabolic risk can help with the prevention of both type 2 diabetes and ASCVD.
  • Lifestyle modifications should be the first line in patients that have metabolic syndrome before the initiation of medication.

Reference for “Who, and When, Should We Screen for Metabolic Risk?”:

Rosenzweig, and J Clin Endocrinol Metab. “Endocrine Society: Most Adults Should Be Screened for Metabolic Risk.” Healio, https://www.healio.com/endocrinology/diabetes/news/online/{c840a96e-3f5a-49a6-a5a2-77ee2511fbf9}/endocrine-society-most-adults-should-be-screened-for-metabolic-risk?M_BT=2469436429117.

Keri Hames, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences