CE/CME

Prediabetes and Metabolic Syndrome: Current Trend

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References

Other interventions
Group-based educational interventions. Innovative methods are needed to successfully implement diabetes prevention measures in the general population. The ADA recommends diabetes self-management education to help those with prediabetes make behavioral changes.8

Education provided in a group setting using a patient-centered approach has been shown to be effective in improving health care outcomes and increasing self-management.8,29,34 Group-based diabetes education programs have also been found to be cost-effective over the long term.8,29 The ultimate goal of a group-based educational program is to improve the lifestyle practices of the participants through healthier eating and higher activity levels, thus preventing or delaying the onset of T2DM.

Culture-specific interventions. Health care providers should consider cultural variations when formulating treatment plans to improve disease outcomes.35 Patients often find it difficult to adopt a new lifestyle that they see as irrelevant to their cultural practices. For example, in one study, low-income Latina women did not consider cervical cancer screenings necessary due to absence of symptoms such as pain.35

Cultural influences are present in patients’ values and beliefs about disease processes, symptoms, prevention, treatment, self-management, and patient-provider relationships.35 Primary care providers must consider these values and beliefs, as well as their own, to avoid bias.

A culturally oriented approach to the management of prediabetes ensures that care is tailored to individual patients’ needs.36 Measures aimed at fostering culturally competent care include programs that provide culture-specific training for health care providers, use of language-appropriate patient education materials, recruitment of bicultural health care providers, and use of interpreter services.35 Culturally relevant care improves the success rate of sustained lifestyle changes in individuals at risk for chronic conditions such as diabetes.36

Surgical intervention. Bariatric surgery, reserved for high-risk individuals (BMI ≥ 35), has been shown to significantly decrease the incidence of T2DM in morbidly obese individuals.8 These benefits are probably related to the immediate metabolic changes that occur following the surgery, as well as the long-term sustained weight loss. For patients who undergo bariatric surgery, it is important to maintain regular follow-up to promote and maintain behavioral changes and identify barriers to a healthy lifestyle.

CONCLUSION
Clinicians must be able to effectively diagnose and treat prediabetes and metabolic syndrome. Due to its chronic nature and the resources needed to manage the disease and its complications, diabetes places an enormous burden on society. Efforts to prevent or delay the onset of diabetes are therefore essential to curb the costs and burden associated with this chronic disease.

While lifestyle changes are considered the mainstay of prediabetes and metabolic syndrome management, pharmacologic treatment may be considered in high-risk individuals. Patient education, though important, will not improve glycemic control or modify learned behaviors on its own. Health care providers should use a patient-centered approach to guide implementation of evidence-based guidelines in individuals with prediabetes and/or metabolic syndrome.8

Furthermore, innovative methods are needed to successfully implement diabetes and CVD prevention measures in the general population. Health care policies must be put in place to proactively encourage disease prevention rather than just focusing on acute care.37 It is important for NPs and PAs to devise viable strategies for the management of prediabetes and metabolic syndrome.

Environmental change must be made at the population level, incorporating lifestyle changes outside the health care system. There must be collaboration among various governmental and social organizations to ensure a society that promotes a healthy lifestyle.

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