Metabolic syndrome care measures

The core logic of effective care for metabolic syndrome is to "center on personalized lifestyle intervention that patients can adhere to for a long time, combined with stratified medication for abnormal indicators and dynamic psychological adjustment. There is no unified plan that applies to everyone." According to the diagnostic standards of the Endocrinology Branch of the Chinese Medical Association in 2023, abdominal obesity (waist circumference ≥ 90cm for men and ≥ 85cm for women), hyperglycemia, hypertension, and dyslipidemia can be diagnosed if 3 out of 4 items are met. The core of care for this type of patients has never been to meet the rigid requirements of perfect health standards, but to find a balance point that fits everyone's life rhythm.

I have been working at a community chronic disease management station for 6 years. The most typical case I have encountered is a 42-year-old Internet programmer. When he arrived, his waist circumference was 98cm, his fasting blood sugar was 6.2mmol/L, his triglyceride was 2.8mmol/L, and his blood pressure was stuck at the critical line of 140/90mmHg, which was enough for three confirmed diagnoses. At the beginning, I gave him a plan of whole grain staple food, one pound of green leafy vegetables per day, and 150 minutes of moderate-intensity aerobics per week according to the regulations. However, within two weeks, he came to complain, saying that he worked overtime every day and didn’t even have time to cook. After get off work, he just wanted to be paralyzed and couldn’t run at all. Later, we discussed and changed all the requirements: get off the bus two stops ahead of the commute and walk briskly for 20 minutes to get some exercise. Just choose ordinary home-cooked food for takeout, but pour out half of the sauce for the bibimbap. The snacks in the afternoon are changed from potato chips to small bags of original nuts. I can drink up to 2 cups of milk tea with 30% sugar per week. There is no need to give up completely. After sticking to it for three months, his waist circumference dropped by 5cm and all indicators returned to the normal range.

When it comes to dietary intervention, there is currently no unified standard answer in the academic community, and there are quite large differences among different schools. The team advocating a very low-carbohydrate diet believes that reducing the proportion of refined carbohydrates to less than 20% of total daily calories can quickly reduce body fat and improve insulin sensitivity. It is especially suitable for young and middle-aged patients with particularly prominent abdominal obesity and no abnormal renal function. ； However, scholars who support the Mediterranean diet believe that long-term very low carbohydrates can easily lead to muscle loss and rebound abnormal blood lipids. Instead, they recommend a combination of whole grains, high-quality fats, and high-quality protein, which is suitable for middle-aged and elderly patients with high uric acid and weak kidney function. In actual care, we do not forcefully recommend any one method. We always let patients try it for two weeks. Whichever method is not uncomfortable to eat and can persist is used. After all, no matter how good the plan is, it is in vain if it cannot be implemented.

Don’t think that nursing only focuses on eating and moving. Many small details that are easy to overlook have a greater impact on metabolism. There used to be a 58-year-old aunt who followed the requirements on diet and exercise, but her blood pressure could not come down. After careful questioning, I found out that she took her granddaughter to bed every night, woke up three or four times a night to tuck the baby in, make milk, and did not get a full night's sleep for half a year. Later, we discussed with her son and daughter-in-law that we would take turns taking care of the children every week so that the aunt could sleep at least 7 hours or more three days a week. After only two weeks, her systolic blood pressure dropped by 12mmHg and stabilized within 130mmHg. What’s interesting is that there is currently controversy over this part of the academic community: one school of thought believes that as long as the total sleep time per day is enough for 7 hours, it doesn’t matter if you sleep in fragments. ； Another school of research shows that cortisol disorders caused by fragmented sleep are more harmful to metabolism than staying up all night. The conclusion is not yet conclusive. When we care, we can only try to remind patients to sleep through the whole night if they can. Oh, by the way, there is another piece of trivia that many people don’t know: Many studies now show that periodontitis can aggravate insulin resistance. We now remind patients with metabolic syndrome to have their teeth cleaned every six months, which is more helpful in controlling blood sugar and blood lipids than many people think.

We have also encountered many pitfalls in medication and care. Many patients panic when they are diagnosed and think that they need to take a lot of medicine to get better. In fact, this is not the case at all: if the indicator is only slightly high and there is no underlying disease or family history, most of the patients can get back down by adjusting their lifestyle for 3 months, and there is no need to rush to take medicine. ； However, if you already have carotid plaque or have a family history of diabetes and high blood pressure, you must start anti-hypertensive and lipid-lowering treatment as soon as possible. If you insist on it, you may cause problems. There are also many patients who stop taking the drug without authorization after hearing that statins hurt the liver. In fact, less than 10% of people will experience intolerance reactions. If the aminotransferase is really elevated after taking a statin, just switch to ezetimibe or a PCSK9 inhibitor. There is no need to endure the side effects and you cannot stop the drug directly.

In fact, after doing chronic disease care for so many years, my biggest feeling is that metabolic syndrome care is never an empty slogan of "keep your mouth shut and open your legs", and it does not require patients to completely give up their existing living habits to become a "health model." Last week, there was a girl who was so anxious after being diagnosed that she couldn't even eat. She checked Baidu every day and felt that she was about to have a myocardial infarction and a stroke. Instead, her blood sugar was getting worse and worse because of the elevated cortisol. Later, I showed her the treatment indicators of several patients in the same community and similar conditions to hers, and she relaxed. Now after 3 months of adjustment, the indicators are basically normal. After all, the essence of nursing, in the final analysis, is to minimize the risk of disease without reducing the patient's quality of life, and only measures that can be adhered to for a long time are truly effective measures.