A panel of US-based experts in cardiology, nephrology, endocrinology, and primary care has prepared specific recommendations for early identification and intervention in obesity, diabetes, and other cardiorenal and metabolic diseases. A detailed report on recommended strategies has been published in the Journal of Diabetes and its Complications.
Study: Early intervention and intensive management of patients with diabetes, cardiorenal, and metabolic diseases. Image Credit: kurhan / Shutterstock
Background
Individuals with obesity and diabetes are more likely to develop cardiorenal and metabolic diseases. An increasing rate of obesity and diabetes in the general population has caused a corresponding increase in specific comorbidities, including metabolic syndrome, atherogenic dyslipidemia, prediabetes, diabetes, non-alcoholic fatty liver disease, atherosclerotic cardiovascular disease and atrial fibrillation, chronic kidney disease, and heart failure.
An expert task force from various biomedical fields has been formed to identify and address the risk factors for these comorbidities. The experts have established specific guidelines for the early detection and intervention of obesity, diabetes, and other cardiorenal and metabolic diseases.
Primary preventive measures
Obesity
Obesity and overweight significantly increase the risk of diabetes, cardiovascular, renal, and metabolic diseases. Individuals with a body mass index (BMI) of ≥30 kg/m2 are considered obese. Such individuals should immediately be evaluated medically for obesity-related disorders, physical functioning, and overall quality of life.
The medical evaluation should include an assessment of oral glucose tolerance, hepatic steatosis and fibrosis, coronary heart disease, kidney function, and other related complications, such as sleep disorders and osteoarthritis.
Weight loss through calorie restriction and physical activity is considered the optimal strategy for obesity management. In addition, metabolic complications can be eased by reducing 5-10% of body weight.
Low-carbohydrate diets are better than low-fat diets in controlling blood levels of glucose and triglycerides. Similarly, regular physical activity helps improve insulin sensitivity, blood pressure, and lipid profile. Collectively, these factors play vital roles in preventing cardiovascular disease, diabetes, and other metabolic diseases.
Besides lifestyle interventions, some obese individuals may need pharmacological therapy. Two clinically-approved drugs, semaglutide, and tirzepatide have shown promising results in reducing body weight and related complications. Endoscopic treatments, such as sleeve gastroplasty and intragastric balloon, can also achieve similar benefits.
Metabolic syndrome
Metabolic syndrome increases the risk of diabetes and atherosclerotic cardiovascular disease. Insulin resistance and increased uric acid levels are the root cause of metabolic syndrome. Therefore, body weight loss, cholesterol-lowering drugs, uric acid-lowering drugs, and anti-hypertension therapies could benefit individuals with metabolic syndrome.
Prediabetes and Diabetes
Both prediabetic and diabetic individuals have a higher risk of developing cardiovascular and metabolic complications. High-throughput metabolomics can help identify prediabetic individuals at a higher risk of developing diabetes.
The presence of retinopathy, neuropathy, nephropathy, and cardiovascular risk factors should be evaluated in both prediabetic and diabetic individuals. Weight reduction through lifestyle or pharmacological interventions is the key to managing prediabetic and diabetic conditions.
Sodium-glucose cotransporter 2 inhibitors and weight-reducing drugs have shown promising outcomes in managing diabetes and related complications. Depending on the medical condition, diabetic individuals can also be treated with blood pressure- and cholesterol-lowering drugs.
Hypertension
The majority of individuals with diabetes develop hypertension as a comorbid condition. Continuous monitoring of blood pressure and maintaining it below 130/80 mmHg is vital for diabetic individuals with hypertension. This helps reduce the risk of cardiovascular and renal complications.
A low-sodium, high-potassium diet with regular physical activity is beneficial for controlling blood pressure. For individuals with blood pressure more than 150/90 mmHg, a combination therapy with renin-angiotensin-aldosterone system inhibitor, calcium channel blocker, and thiazide-type diuretic is recommended.
Lipid abnormalities
The general adult population should undergo lipid profile testing to establish the baseline status, followed by a re-checkup every 3-5 years. In addition, individuals with obesity, diabetes, or other metabolic diseases should be monitored annually.
Physical exercise and diet modifications, such as restricted intake of saturated fat, carbohydrate, and alcohol, are critical lifestyle interventions to maintain a healthy lipid profile.
Statins are the first treatment choice for individuals with high low-density lipoprotein-cholesterol (LDL-C) and dyslipidemia. Individuals with LDL-C levels 50% above the recommended levels might require combination therapy.
Prevention of disease progression
Patients with non-alcoholic fatty liver disease are advised to reduce body weight and alcohol intake and clinically manage cardiorenal and metabolic risk factors to avoid disease progression to non-alcoholic steatohepatitis.
The risk of atherosclerotic cardiovascular disease development can be avoided by assessing coronary artery calcium, a marker to detect subclinical atherosclerosis. In addition, Statin therapy is a valuable intervention for preventing atherosclerosis. Antiplatelet therapy and LDL-C-lowering therapy are considered secondary preventive interventions.
Patients with obesity or diabetes who have atherosclerotic cardiovascular disease or other cardiovascular problems can benefit from drugs that lower heart rate and anticoagulant or antiplatelet medications.
Chronic kidney disease is a frequently-observed comorbidity in patients with diabetes and hypertension. It increases the risk of atherosclerotic cardiovascular disease and heart failure. A reduced estimated glomerular filtration rate and elevated urine albumin-creatinine ratio are the key markers for detecting chronic kidney disease.
To avoid hypertension and heart failure, a low-sodium, low-protein diet is recommended for patients with chronic kidney disease. In addition, treatment with renin-angiotensin-aldosterone system inhibitors and sodium-glucose cotransporter 2 inhibitors is advised for these patients.
N-terminal pro-B-type natriuretic peptide (NT-proBNP), B-type natriuretic peptide (BNP), and high-sensitivity cardiac troponin T are valuable biomarkers to identify patients at higher risk of heart failure. Therefore, lifestyle and pharmacological interventions are required to treat heart failure-related comorbidities.
Global gap in diabetes prevalence and treatment has widened since 1990