The Metabolic Syndrome is a recent addition to the non-communicable disease conglomerate. The metabolic syndrome is characterized by a group of metabolic risk factors in one person. They include:

1. Abdominal obesity
2. Atherogenic dyslipidemia
3. Elevated blood pressure
4. Insulin resistance or glucose intolerance
5. Prothrombotic state
6. Proinflammatory state

People with the metabolic syndrome are at increased risk of coronary heart disease and other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes.

The clinical identification of metabolic syndrome is based on measures of abdominal obesity, atherogenic dyslipidaemia, hypertension, and glucose intolerance. The World Health Organization’s definition of metabolic syndrome requires evidence of insulin resistance and measurement of fasting insulin or its surrogates as essential criteria. However, the Adult Treatment Panel III of the US National Cholesterol Education Program (NCEP) proposed a simpler definition, developed for clinical use and not including any estimation of insulin resistance. People meeting three of the following criteria qualify as having the metabolic syndrome: raised blood pressure (> 130/85 mm Hg), a low serum concentration of HDL cholesterol (< 1.04 mmol/l in men and < 1.29 mmol/l in women), a high serum triglyceride concentration (> 1.69 mmol/l), a high fasting plasma glucose concentration (> 6.1 mmol/l), and abdominal obesity (waist circumference > 102 cm in men and > 88 cm in women). A new definition, proposed recently by the International Diabetes Federation, has central obesity as an essential criterion, with a range of cut-offs for waist circumference for people from different ethnic groups.

The prevalence of metabolic syndrome in the adult population in developed countries is 22-39% and varies depending on the definition used and on ethnicity.  The metabolic syndrome is associated in men with a fourfold increase in risk for fatal CHD, and a twofold greater risk of CVD and all-cause mortality, even after adjustment for age, LDL-cholesterol, smoking, and family history of CHD.  The metabolic syndrome is associated with increased CHD risk in women.  Patients with the metabolic syndrome have a five to nine fold increased risk of developing diabetes. Hence it is important to screen a person with hypertension for all the other constituents of metabolic syndrome.

All tests for the diagnosis and management of Metabolic Syndrome are available at Vivek Labs.

Diabetes, a global public health problem is now emerging as a pandemic and by the end of  2025, three quarter of the world’s 300 million adults with diabetes be in non industrialized countries and almost a third in India and China. The prevalence of diabetes in India is showing a sharp upswing as is evident from secular trends from different parts of the sub continent. Environmental and life style changes resulting from industrialization and migration to urban environment from rural setting may be responsible to a large extend for this epidemic of Type II Diabetes in Indians.

Most NCD’s cannot be cured once they set in and the long term management is expensive to individuals and their family. Increased morbidity and premature mortality caused by diabetes have resulted in escalating costs, both in terms of medical care and loss of manpower resources. The improved understanding of causes and mechanism of major types of diabetes now provides some indication of how they could be prevented.

A. Primordial prevention:- It involves preventing the emergence and spread of risk factors and life styles that have not yet appeared or become endemic. Countries should preserve their traditional eating patterns and life styles associated with low risk factors. A multifactorial approach should be adapted to control or modify as many factors as possible. The aim should be to change the community as a whole, not the individual subjects living in it.

B. Primary prevention: - There are two approaches for primary prevention of type II diabetes.
1.  The population approach
2.  The high risk approach

The population approach :- A population strategy to alter the life style and environmental characteristics, and their social and economic determinants and the underlying causes of different types of diabetes. The Specific interventions considered in the population strategy are as follows.

1. Dietary changes;- In India, as urbanization and economic growth occurs; there are more deviations in the dietary patterns which are influenced by varied cultural and social norms. The WHO Expert Committee considered the following dietary changes to be appropriate for high incidence population.

1. Reduction of fat intake to 20-30 percent of total energy intake.
2. Saturated fat must be limited to less than 10%of total energy intake.
3. Reduction of dietary cholesterol to below lOOmg peri 000 kcal per day.
4. An increase in complex carbohydrate (vegetables, fruits, whole grains, legumes) consumption.
5. Avoid alcohol consumption
6. Reduction of fat intake to 5g or less.

The most basic consideration is that the food energy intake should not be greater than what is necessary for energy expenditure. It requires modification of the patient’s behavior and strong motivation to loose weight and to maintain ideal weight.

2. Physical activity: - Regular physical exercise should be apart of normal daily life. It is the key to an increased energy expenditure. The benefits obtained during exercise are

1. Helps to reduce body weight
2. Helps in long term glycaemic control which is achieved by increased insulin receptors and increase in insulin sensitivity
3. Helps in reducing requirement; of onil hypoglyccmic agents /or insulin
4. Improvement in hypertension
5. Improvement in lipid profile by reduction of S. triglycerides& S. cholesterol. reduction of IJDL &VLDL, Increase in HDL
6. Improved cardiovascular function
7. Increase body fitness by stamina.
8. Increase sense of well being
9. Improve quality of life
10. Exercise therapy has a special role in the prevention of atherosclerosis and ageing

Choice of exercise :- For old age people brisk walking is appropriate. For young people can do jogging, cycling, out door games.
Types of exercise:- ln aerobic exercise like walking, brisk walking, cycling, swimming, running outdoor games etc the energy utilization is gradual and blood circulation increases to various organs of the body. In Anaerobic exercise like weight lifting, hand grip exercise, muscles are not dependent onoxygen for energy.
Duration: -  Should have a warming up and cooling down for a period of 5-15 mts. usual duration is 20-60 mts.
Frequency: -To get desired benefit, one should exercise at least 4-5 days in a week.
Intensity: -Should be uninterrupted and should gradually increase the heart rate to 70-80% of the maximum heart rate.
Maximum heart rate = 220 — Age of the person’(in years).

3. Obesity prevention : - Prevention should begin in early childhood. This can be achieved by dietary changes, increased physical activity and a combination of bom

4. Smoking cessation : - The goal is to achieve a smoke free society for which a comprehensive programme would be required which includes effective information and education activities, legislative restrictions, fiscal measures and smoking cessation programmes.

5. Blood pressure : - The goal of population approach is to reduce the mean Population blood pressure levels because even a small reduction in the average BP of the whole population would produce a large reduction in the incidence in the cardiovascular complications.

The high risk approach : - Preventive care to those who can be identified as being at special risk of developing diabetes. This includes those with strong family history of diabetes, over nutrition, obesity, sedentary life style. People at special risk can be found out by means of tests like impaired glucose tolerance test. Once they are identified, bring them under preventive care and motivate them to take positive action against all the identified risk factors.

C. Secondary prevention : - It must be seen as a continuation of primary prevention. The aim of secondary prevention is to prevent the recurrence and progression of disease so diabetes must be adequately treated to maintain blood glucose within normal limits and to maintain normal body weight. Good control of blood glucose protect against the development of complications. For this proper and frequent monitoring of the blood glucose levels is very important. Primary health care is of great importance in the diabetes management since most care is obtained at mis level.

D.Tertiary Prevention :- Diabetes is a major cause of disability through its complications. The services of specialized clinics and laboratories help to diagnose and manage such complications.

Vivek Labs services include a complete Diabetes Panel for the diagnosis, monitoring and management of diabetes.