The early detection and intervention of obesity, diabetes, and other cardiorenal and metabolic illnesses have been the subject of specific recommendations from a group of US-based specialists in cardiology, nephrology, endocrinology, and primary care. The Journal of Diabetes and its Complications has released a thorough study on suggested tactics.
Background
Cardiorenal and metabolic disorders are more prone to develop in people with obesity and diabetes. Specific comorbidities, such as metabolic syndrome, atherogenic dyslipidemia, prediabetes, diabetes, non-alcoholic fatty liver disease, atherosclerotic cardiovascular disease and atrial fibrillation, chronic kidney disease, and heart failure, have increased in proportion to an increase in the prevalence of obesity and diabetes in the general population.
To determine and address the risk factors for these comorbidities, a task force of experts from several biomedical domains has been established. For the early detection and treatment of obesity, diabetes, and other cardiorenal and metabolic illnesses, specialists have produced detailed guidelines.
first-line safeguards
Obesity
Diabetes, cardiovascular, renal, and metabolic illnesses are all considerably more likely to develop in those who are obese or overweight. Obese people are those whose body mass index (BMI) is greater than or equal to 30 kg/m2. Such people need to be assessed medically right once for diseases linked to obesity, physical ability, and general quality of life.
Oral glucose tolerance, hepatic steatosis and fibrosis, coronary heart disease, kidney function, and other relevant issues, such as sleep difficulties and osteoarthritis, should all be evaluated during the medical examination.
The most effective method for managing obesity is weight loss through calorie restriction and exercise. In addition, losing 5–10% of one’s body weight can help with metabolic issues.
Low-fat diets are less effective than low-carbohydrate diets at lowering triglycerides and glucose levels in the blood. Similar to how exercise on a regular basis helps lower blood pressure, lower cholesterol, and enhance insulin sensitivity. These elements work together to prevent metabolic illnesses like diabetes, heart disease, and obesity.
Aside from lifestyle changes, some fat people may also require medication. Semaglutide and tirzepatide, two medications with clinical approval, have demonstrated encouraging outcomes in lowering body weight and complications associated with it. Similar results can also be obtained with endoscopic procedures like sleeve gastroplasty and intragastric ballooning.
Diabetes syndrome
Diabetes and atherosclerotic cardiovascular disease risk factors for metabolic syndrome are increased. The primary causes of metabolic syndrome are elevated uric acid levels and insulin resistance. Therefore, treatments for hypertension, cholesterol, uric acid, and body weight decrease may be helpful for people with metabolic syndrome.
Obesity and Diabetes
People who are prediabetic or diabetic are more likely to experience cardiovascular and metabolic problems. High-throughput metabolomics can assist in identifying prediabetic people who are more likely to acquire diabetes.
Both prediabetic and diabetic people should have their cardiovascular risk factors and the existence of retinopathy, neuropathy, nephropathy, and other diseases assessed. The cornerstone to addressing prediabetic and diabetic diseases is weight loss through dietary or pharmaceutical therapies.
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Weight-reducing medications and sodium-glucose cotransporter 2 inhibitors have demonstrated promising results in the treatment of diabetes and its comorbidities. Diabetics may also benefit from medications that lower cholesterol and blood pressure, depending on their medical condition.
Hypertension
Most people with diabetes also have hypertension, which is a comorbid illness. For diabetics with hypertension, it’s crucial to continuously monitor blood pressure and keep it below 130/80 mmHg. This lessens the possibility of kidney and cardiovascular problems.
For blood pressure control, a low-sodium, high-potassium diet, and regular exercise are effective. Combined therapy with a calcium channel blocker, renin-angiotensin-aldosterone system inhibitor, and thiazide-type diuretic is advised for people whose blood pressure is higher than 150/90 mmHg.
anomalies in lipids
Lipid profile testing for the general adult population should be done to determine their baseline condition, then they should get checked again every three to five years. Additionally, people with diabetes, obesity or other metabolic illnesses need to undergo annual monitoring.
To maintain a healthy lipid profile, physical activity and dietary changes, such as limiting saturated fat, carbohydrates, and alcohol intake, are essential.
When someone has dyslipidemia and high levels of low-density lipoprotein cholesterol (LDL-C), statins are their first line of treatment. People who have LDL-C levels that are 50% higher than what is advised may need combo therapy.
preventing the spread of disease
To prevent the disease from progressing to non-alcoholic steatohepatitis, patients with non-alcoholic fatty liver disease are advised to lower body weight, limit alcohol use, and clinically control cardiorenal and metabolic risk factors.
Assessing coronary artery calcium, a measure to find subclinical atherosclerosis can help reduce the chance of developing atherosclerotic cardiovascular disease. Statin medication is a helpful treatment option for avoiding atherosclerosis as well. LDL-C lowering medication and antiplatelet treatment are regarded as secondary preventative measures.
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Anticoagulant or antiplatelet therapies, as well as those with obesity or diabetes who have atherosclerotic cardiovascular disease or other cardiovascular issues, may benefit from these treatments.
Patients with diabetes and hypertension frequently exhibit chronic kidney disease as a concomitant condition. Heart failure and atherosclerotic cardiovascular disease become more likely as a result. The two main indicators of chronic kidney disease are an elevated urine albumin-creatinine ratio and a decreased estimated glomerular filtration rate.
Patients with chronic kidney disease are advised to follow a low-sodium, low-protein diet in order to prevent hypertension and heart failure. These individuals should also receive treatment with sodium-glucose cotransporter 2 inhibitors and renin-angiotensin-aldosterone system inhibitors.
The biomarkers NT-proBNP, B-type natriuretic peptide, and high-sensitivity cardiac troponin T are helpful in identifying patients who are more likely to develop heart failure. To treat heart failure-related comorbidities, lifestyle and pharmaceutical therapies are therefore necessary.
