The term “Metabolic Health” is popularly used these days referring to the absence of any feature of metabolic syndrome. Metabolic syndrome is defined as 3 of 5 of the following criteria: blood pressure greater than 120/80; fasting glucose greater than 100 mg/dl and/or HbA1C greater than 5.7%; triglycerides over 150 mg/dl; HDL less than 50 mg/dl in women or less than 40 mg/dl in men and a waistline over 40 inches in men and 34.6 in women.
So, what percentage of the population is “metabolically” healthy? Only 12%. That’s according to research from the University of North Carolina, Chapel Hill, which performed a study analyzing data from NHANES (National Health and Nutrition Examination Survey) ranging from 2009 to 2016 comprised of more than 8,000 patients. Patients were considered healthy if they lacked all five of the criteria in the absence of any medication used to treat those features. More than 88% of the population carried at least one of the five risk factors for progression to diabetes and/or cardiovascular disease.
I ran a busy diabetes/endocrinology practice for 24 years in Nashville, Tennessee. Most of my patients already had overt diabetes and advanced disease. However, a significant number came to me for other reasons such as thyroid, adrenal, pituitary and parathyroid disease. Many times, I would evaluate the problem at hand and come up with a solution that required long term monitoring while noting that this abnormality did not represent an immediate threat to the individual’s overall health. However, after assessing the patients, I noted that many had metabolic syndrome which was unrelated to the presenting problem. It was very difficult for me to ignore these life-threatening issues.
Studies have shown that patients with Type 2 diabetes, have had insulin resistance for many years prior to the diagnosis of diabetes. Insulin resistance means that the body does not use glucose normally and the pancreas is required to produce large amounts of insulin in order to keep blood sugars normal. After many years of insulin over-secretion, the beta cells of the pancreas (that make insulin) eventually fail. It is when the pancreas can no longer keep up with the increased insulin demand that diabetes finally occurs.
Proactive Steps key to Prevention
What if we identified these patients at risk early in the process so that we could delay, or better yet, prevent the onset of diabetes and cardiovascular disease as well? It is much better to prevent disease with lifestyle changes and medication (and less costly) than waiting until the disease has already resulted. As the old saying goes, an ounce of prevention is worth a pound of cure!
Identification of the problem is straightforward. Two of the five criteria for metabolic syndrome (triglycerides and high-density lipoprotein) are documented in a standard lipid panel. A1C and fasting glucose are also easily identified from a morning blood draw. Blood pressure can be measured both at a physician’s office and at home. I recommend home blood pressure monitoring for many patients so that we can see what the results are at various times of day under typical life circumstances. The waist circumference can be obtained with a tape measure.
A more precise level of glucose dysregulation can be documented by wearing a continuous glucose monitor (CGM). A CGM measures interstitial blood glucose approximately every 5 minutes. Sensors can typically be used 10 to 14 days before expiration. This data gives a real-time view of blood sugar levels throughout days and nights continuously. Many patients with early glucose intolerance will have post-meal glucose excursions. While the fasting blood glucose and A1C may remain normal, the pancreas can’t handle the glucose load of the meal properly causing blood sugars to rise inappropriately, albeit not yet into the diabetic range. This phenomenon, if documented, identifies patients at risk for diabetes who do not yet have abnormalities of fasting glucose or A1C.
Over the last several years a pharmaceutical explosion has occurred offering new drugs for diabetes that promote weight loss which is sometimes dramatic. We now have effective drugs that can both treat and prevent diabetes, help people slim down and help with cardiovascular disease prevention. As the new year approaches, now is a great time to consider your own metabolic health!
A version of this post appeared in Health & Wellness magazine.
