Metabolic Syndrome and Medication Use

This story shows how medication use can be reduced or avoided by “unplugging” metabolic syndrome.

Metabolic Syndrome is very common.

Could this be a story like your’s or similar to the health situation of someone close to you?

Published in BMJ, a doctor tells the story of how he thought through the question of how best to approach the care of one of his patients. The patient was interested in avoiding any medications that were not truly necessary.

There is so much in this story that is important, given how many people have insulin resistance –

  • in its early non-obvious phases,
  • evident in metabolic syndrome,
  • as pre-diabetes or
  • as type 2 diabetes.

In Metabolic Syndrome, the underlying problem is insulin resistance, which means that the person’s body cannot handle carbohydrates well.

The deeper underlying problem (why one person’s body comes to be insulin resistant, and another person’s body does not have that problem) is not really understood, so there is not a true cure for the tendency to develop insulin resistance.

Still, the harms that come from Metabolic Syndrome can be largely avoided simply by keeping carbohydrate intake to level that the body can handle well. For some people, the insulin resistance is such a particular problem in the liver that the liver makes a lot of glucose, keeping the blood glucose high even when someone is not getting glucose from what they are eating (sugars, starch). So some people need some medication in addition to keeping their carb intake from food within what their body can handle.

So, … can this man’s medications be reduced?

Paper: A patient request for some “deprescribing”
BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4023   LINK

“A 52 year old man with a history of type 2 diabetes for 14 years and hypertension for nine years presented to his general practitioner. He was a non-smoker with an alcohol intake of eight units a week.

He had been experiencing bloating, abdominal pains, and erratic motions for more than a year. Because he drove about 12 000 miles a year for his job he found the loose motions “a real worry.”

He wondered whether any of his problems might be caused by his drugs and asked if he could cut down on any if they weren’t all needed. He admitted to being afraid that his diabetic control might deteriorate and that he might need insulin, like some of his relatives who also had diabetes.

He was taking aspirin 75 mg once daily, metformin 500 mg three times daily, perindopril 4 mg daily, and simvastatin 40 mg at night.”

The outcome?

  • “The patient steadily lost a total of 16 kg over seven months and successfully stopped all four prescribed drugs, thereby achieving his goal of being medication-free.”
  • “In general he reports feeling “just much younger again.” “

The key is – how was this accomplished?

More, what is the underlying explanation? This is all explained, along with giving a list of all the research studies that contributed to the decisions made.

Cardiovascular Risk Calculator On-line

The case report makes use of a “risk calculator” developed here locally. Because artery disease develops in a hidden way, various attempts have been made to develop risk calculators to help make treatment choices. Any calculator will not be truly accurate for an individual, but we are short of ideal ways to consider how much at risk for artery disease one or another person might be. These risk calculators are an integral part of medical care.

“James McCormack, a professor in the faculty of pharmaceutical sciences at the University of British Columbia in Canada, has developed a risk calculator that facilitates discussion of risks and harms with patients (the studies that he used as a basis for this can be found under FAQ). The calculator can demonstrate to patients the impact of various lifestyle and drug interventions in a similar case to theirs, but before drugs are started.”

The Absolute CVD Risk/Benefit Calculator  LINK

Click on the three different choices across the top of the page. These are three different calculators. Notice that the range of questions differs for different calculators, so be sure to re-do the questions as needed. Then, you can try entering different answers or clicking on different treatment options to see what the effect would be on the calculated risk.

Some risk factors are under your control. Some, such as family history, are not. Unfortunately, the calculators are not able to analyze what the additive effect of two different treatment/lifestyle options would be. Also, a number of treatment or lifestyle choices are not given as options. For example, you can only click for diabetes yes or no. There is no way of reflecting the impact of better and worse blood glucose control over time.

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