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Metabolic Risk

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Key Points 2 ➤ Individuals should be screened for metabolic risk, in five categories: • Elevated waist circumference • Decreased high density lipoprotein (HDL) cholesterol • Elevated serum triglycerides • Elevated blood pressure • Elevated blood glucose ➤ Three or more categories being abnormal should alert the clinician to a patient's increased risk for atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM) (i.e., metabolic risk). ➤ Endocrine Society (ES) recommends that providers measure waist circumference as part of the initial evaluation. (Note, however, that this does not replace the measurement of weight.) ➤ Behavioral change should be the first-line therapy for prevention and should include changes to diet, increased exercise, and weight loss. ➤ Persons identified as having metabolic risk should undergo risk scoring to identify the 10-year risk for ASCVD. Diagnosis Definitions and Diagnosis ➤ 1.1: In individuals aged 40–75 years in the office setting, ES suggests providers screen for all five components of metabolic risk at the clinical visit. The finding of at least three components should specifically alert the clinician to a patient at metabolic risk (at higher risk for ASCVD and T2DM). (2|⊕ ). Technical Remarks: ▶ The main components of metabolic risk as defined in this guideline are 1) elevated blood pressure, 2) increased waist circumference, 3) elevated fasting triglycerides, 4) low high-density lipoprotein-cholesterol (HDL-C), and 5) elevated glycemia. ▶ Elevated glycemia should be determined either by hemoglobin A1c, fasting glucose, or 2-hour glucose with a second test for confirmation using a new blood sample. ▶ Testing for additional biological markers (e.g., high-sensitivity C-reactive protein) associated with metabolic risk should be limited to subpopulations. ▶ This recommendation is specifically for adults aged 40–75 years, those for whom the interventions have the greatest impact and evidence for efficacy. This does not restrict screening for appropriate individuals outside of this age range, especially those who are younger.

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