Although the etiology of metabolic syndrome is not fully known, insulin resistance is thought to play a key role. There are various findings showing the relationships of all components of metabolic syndrome with each other and with insulin resistance.
The frequency of metabolic syndrome increases with advancing age and body weight increase. In the USA, the prevalence of metabolic syndrome in people aged 20 and over was found to be 27%, and it was found that the frequency of metabolic syndrome was increasing more rapidly in women. According to the results of METSAR (Turkish Metabolic Syndrome Research) conducted in our country in 2004, the frequency of metabolic syndrome in adults aged 20 and over was found to be 33.9%. In this study, the frequency of metabolic syndrome was found to be higher in women than in men. (39.6% in women, 28% in men). In another comprehensive study, TEKHARF (Prevalence of Heart Disease and Risk Factors in Adults in Turkey), the frequency of metabolic syndrome was found to be 28% in men and 45% in women aged 30 and over. In the TURDEP (Turkish Diabetes Epidemiology) study, diabetes mellitus was found in 7.2% of our adults, glucose tolerance disorder in 6.8%, and obesity in 22%.
Metabolic Syndrome Diagnostic Criteria(presence of three of these five conditions makes the diagnosis)
1. Waist circumference (abdominal obesity) >88cm in women - >102cm in men
2. Triglycerides >150mg/dl
3. HDL <40mg/dl in men - <50mg/dl in women
4. Blood pressure >130/85mmHg or hypertension under treatment
5. Fasting glucose >100mg/dl
Obesity is one of the most important components of metabolic syndrome and is closely related to insulin resistance. Clearly, most individuals with metabolic syndrome are either overweight or severely obese, and most people with insulin resistance have abdominal obesity.
Insulin resistance, which is often seen in type 2 diabetes, is found in individuals with normal glucose tolerance and no diabetes. can also be seen. The detection of insulin resistance in relatives of type 2 diabetics who are not obese and do not have diabetes supports the role of genetic predisposition. Obesity, sedentary lifestyle, smoking, low birth weight and p Perinatal malnutrition has also been associated with the development of insulin resistance.
Insulin resistance increases sympathetic nervous system activation, leading to hemodynamic disorders such as increased renal sodium retention and increased blood pressure. Approximately 50% of hypertensive patients have insulin resistance. Polycystic ovary syndrome (PCOS) is one of the clinical conditions that progresses with insulin resistance. In addition, nonalcoholic steatohepatitis (NASH) and some cancers may also be accompanied by insulin resistance/hyperinsulinemia. Insulin resistance affects the development of atherosclerosis and cardiovascular events independently of other risk factors. It is thought that immunity and inflammation are effective in the pathophysiological role played by insulin resistance in metabolic syndrome.
In the definition of impaired fasting glucose (IFP), fasting glucose levels are accepted to be between 110 and 126mg/dl, while fasting glucose levels are considered to be between 110 and 126mg/dl. At this time, the lower limit has been lowered even further and recommended to be between 100 and 126mg/dl.
Impaired glucose tolerance (IGT)on the other hand, the 2nd hour OGTT values are between 140 and 200mg/dl. is located between. BAG and BGT can occur together or independently of each other. The risk of developing diabetes mellitus and macrovascular complications is high in these diseases. Approximately one-third of patients may develop overt diabetes within 10 years. Insulin resistance may also be found in people with normal fasting glucose levels.
Various methods are used to evaluate insulin sensitivity.Homeostasis Model Assessment (HOMA)is considered the gold standard today. In this method, a single fasting insulin and fasting glucose measurement is sufficient.
HOMA IR=Fasting insulinxfasting glucose/405
This value of 2.5 and above is significant for insulin resistance.
TREATMENT:
Large, randomized studies have been published for the treatment of metabolic syndrome. First of all, it should be aimed to correct insulin resistance, which is considered a basic disorder. In addition, diabetes, hypertension and cardiovascular diseases can be prevented or delayed by controlling each component of the metabolic syndrome separately. must be ensured. The primary approach should be the regulation of lifestyle. Weight loss achieved through an appropriate nutrition and exercise program has a corrective effect on all disorders seen in metabolic syndrome. It has been shown that general and cardiovascular mortality can be reduced with this approach.
In cases where lifestyle changes are insufficient, the use of agents that increase insulin sensitivity may be considered. Metformin and thiazolidinediones have effects on reducing insulin resistance. It has been shown that the risk of developing type 2 diabetes is reduced with metformin in obese people with glucose tolerance disorders and with pioglitazone in women with a history of gestational diabetes.
While metformin improves insulin sensitivity at the liver level, thiazolidinediones are more effective in improving insulin sensitivity in peripheral adipose tissue.
In summary, people who have started to gain weight lately even though they do not eat much, people who cannot lose weight despite dieting, people who have an increased desire to eat sweets excessively and especially at night, people whose hands and feet shake when they are hungry, people who have increased body hair. We recommend that people who start to develop acne in different parts of the face and body, women who experience menstrual irregularities, and people who have a family history of diabetes should be evaluated for "insulin resistance".
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