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- May 11, 2008 |
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CME on Diabetes is a website built to transmit top-level CME conferences given by international experts in endocrinology, insulin resistance, prediabetes, metabolic syndrome and type 2 diabetes. More than 2.6 million slides have been viewed since the website launch. Thank you for your continued support and commitment!
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"The Metabolic Syndrome -The Clinicians' Point of View"Prof. Gerard Slama (biography)
English - 2005-04-14 - 29 minutes
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Summary :
The concept of metabolic syndrome was suspected in the 1950's by a clinician, Jean Vague, in Marseille, France. This remarkable physician noticed that women exhibiting abdominal obesity were more frequently suffering from diabetes, hypertension, and cardiovascular complications. With the thousand of epidemiological and observational studies witch have appeared since, the clinician can only be convinced that he is facing a true disease, of epidemic spreading, and be tempted to actively intervene. The first stage of his thinking is to make a choice between the numerous definitions proposed (WHO, IDF, EGIRE, NCEP ATP III etc... ) : all of them are valid once and all carry the same drawback : definition of various thresholds which all are more or less arbitrary, manichean. The clinician could be more attracted by a less strict definition which includes progression of signs and symptoms over time in the unfavourable direction. The question is then what to do particularly if the syndrome is not recognized as a disease what it is in the USA and is not yet the case in Europe. The answer is easy when all the criteria are each individually above the recognized thresholds for intervention: the "polypill" is clearly indicated along with lifestyle modifications. The question is still difficult to answer when all the parameters are only slightly disturbed, below intervention thresholds. Three attitudes are possible : 1) the "regulation ruled attitude" : the metabolic syndrome has not yet legal existence, the only answer possible is lifestyle modifications. 2) the academic attitude: to design a prospective epidemiological study to compare the relative merits of each definition to predict a significant morbid-mortality increase in this border line population, then design a prospective interventional study comparing different strategies...and wait fifteen years to obtain the results. 3) A more active attitude would be to utilize the concept of the polypill before having more evidence for its applicability.
Conclusion : facing the large bulk of evidence that the dysmetabolic syndrome is affecting more and more people with an increased risk of morbi-mortality, the clinician is strongly driven to react actively. He is pushed in this direction by the pharmaceutical industry and is not indifferent to the economical burden of his decisions.
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The partners in the Metabolic Syndrome Polylogue
• The regulatory oriented/legalistic approach to the management of patients with the metabolic syndrome
• The academic (prudent) approach to the management of patients with the metabolic syndrome
• The activist approach to the management of patients with the metabolic syndrome
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