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Syndrome
Components •T2DM
•CVD
• Abdominal •Hyperuricemia
obesity •PCOS
• Abdominal obesity
• Inactivity • Insulin resistance •OSA
• Ethnicity •Fatty liver disease
• Elevated triglycerides
• Age
• Low HDL
• Gender • High blood pressure
Causes Consequences
T2DM=Type 2 Diabetes; CVD=Cardiovascular disease,
PCOS= Polycystic Ovary Syndrome , OSA=obstructive sleep apnea
Diagnostic Criteria: Pick 3
Fasting glucose ≥100 mg/dL OR drug therapy for elevated blood glucose
Fasting glucose ≥100 mg/dL OR drug therapy for elevated blood glucose
Managing
Lifestyle
underlying
modifications
risk factors
Reduce risk
of ASCVD &
T2DM
Management – Lifestyle Modifications
Diet
Physical
Activity
Behavioral
Changes
Behavioral Changes
• Examples
• Set short and long term goals
• Create non-food related rewards
• Do not multitask when eating
• Calories count
• Monitor exercise, weight, and food
• Meal prep
• Stress reduction
• Motivational interviewing
Management – Lifestyle Modifications
Diet
Physical
Activity
Behavioral
Changes
Diet Changes
• Dietary Approaches to Stop
Hypertension (DASH)
• Limits foods high in saturated fat, sodium,
and sugar and has shown benefit in blood
pressure and LDL
• Vegetarian
• Mediterranean
• Plant based diet and limiting saturated fats
• Daily caloric intake
• Women: 1,200-1,500 kcal/day
• Men: 1,500-1,800 kcal/day
Diet
Physical
Activity
Behavioral
Changes
Physical Activity
Managing
Lifestyle
underlying
modifications
risk factors
Reduce risk
of ASCVD &
T2DM
Containing Comorbidities
Obesity
2015
2014
2013
2012
2011
Containing Comorbidities: Obesity
Calories
Goals of Managing Obesity
7-10 % weight loss within 6-12 months
Decrease 500-1,000 calories per day
BMI Calculations
Weight
Failed Related
Lifestyle Complications
Regained Therapy
Weight
• Lipase inhibitor
• Decreases dietary fat by 30%
• Indication
• BMI of 27 or more with complications
• Complications include T2DM, HTN, HLD
• BMI of 30 or more
• Pearls
• Take within 1 hour of each meal and skip dose if skipping meal
• Contraindicated in pregnancy, malabsorption syndrome, cholestasis, and
nephropathy
Lorcaserin
• Belviq 10mg PO BID
• Indication
• BMI of 27 or more with complications
• Complications include T2DM, HTN, HLD
• BMI of 30 or more
• Pearls
• After 12 weeks of use, if patient has not lost at least 5% of body weight medication
considered failed and should be discontinued
• Use in CrCl<30 mL/min is not recommended
• Caution with combination use of serotonin agonists due to risk of serotonin syndrome
Serotonin Syndrome
• Indication
• BMI of 27 or more with complications
• Complications include T2DM, HTN, HLD
• BMI of 30 or more
• Pearls
• Side effects: hypertension, palpitations, arrhythmias, and insomnia
• Monitor waist circumference and weight every month for 3 months
• Drug interactions
• Increase effect of anti-diabetic medications
• Risk of serotonin syndrome with serotonin agonists (example: SSRIs)
Sympathomimetic Agents: Phentermine
• Adipex-P ODT 15-30 mg PO QAM
• Lomaira IR 15-37.5 mg PO daily
• CrCl 15-30 mL/min max dose: 15mg PO daily
• Indication
• BMI of 27 or more with complications
• Complications include T2DM, HTN, HLD
• BMI of 30 or more
• Pearls
• Side effects: hypertension, palpitations, arrhythmias, and insomnia
• Monitor waist circumference and weight every month for 3 months
• Drug interactions
• Increase effect of anti-diabetic medications
• Risk of serotonin syndrome with serotonin agonists (example: SSRIs)
Sympathomimetic Agents: Phentermine
• Indication
• BMI of 27 or more with complications
• Complications include T2DM, HTN, HLD
• BMI of 30 or more
Bupropion/Naltrexone
• Contrave 8/90 mg PO for 7 days, then increase to 8/90 mg PO BID for 7 days, then
16/180 mg PO QAM and 8/90 mg PO QPM for 7 days, then 16/180 mg PO BID
• Indication
• BMI of 27 or more with complications
• Complications include T2DM, HTN, HLD
• BMI of 30 or more
• Pearls
• Side effects: nausea, vomiting, dizziness, insomnia, dry mouth, diarrhea
• If weight loss less than 5% after 12 weeks of maintenance dose then discontinue
• Contraindications
• Uncontrolled HTN, seizure history, anorexia/bulimia history, or alcohol/drug withdrawal
Liraglutide
• Saxenda 0.6 mg SQ daily for 7 days then increase by 0.6 mg SQ every 7 days
• Max dose: 3 mg SQ daily
• Indication
• BMI of 27 or more with complications
• Complications include T2DM, HTN, HLD
• BMI of 30 or more
• Pearls
• Not to be confused for Victoza which is indicated for diabetes management at a lower
dose (maximum dose of 1.8 mg SQ daily)
• Side effects: nausea and diarrhea, hypoglycemia, tachycardia, and injection site
reaction
• Contraindications
• Pancreatitis and thyroid cancer
Medications Dose Side Effects Clinical Pearls Contraindication
Cramps, oily stool, Take within 1 hour of each meal Pregnancy,
Orlistat 60-120mg TID flatulence, urgency, Decreases absorption of vitamin K and malabsorption syndrome,
diarrhea contraceptive agents cholestasis, nephropathy
HTN, palpitations, Interacts with DM medications. May need to MAOI require 14 day
Phendimetrazine 35mg BID-TID
arrhythmia, insomnia decrease DM dose washout
HTN, palpitations, Interacts with DM medications. May need to MAOI require 14 day
Diethylpropion I25mg TID
arrhythmia, insomnia decrease DM dose washout