Clinical Assessment: Dysglycemia, Dyslipidemia, Hypertension, Obstructive Sleep ApneaSaturday, November 5, 2011
Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.
This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.
Patients who develop type 2 diabetes experience a progressive deterioration of glucose tolerance over time, from normoglycemia to impaired fasting glucose or impaired glucose tolerance, to overt diabetes. Most patients with type 2 diabetes are obese, and abdominal obesity has been recognized as a significant risk factor for the development of type 2 diabetes. With the exception of metformin, the pharmacological treatment of diabetes generally promotes weight gain. This includes sulphonylureas, thiazolidinediones, and most insulins. Newer hypoglycemic agents including insulins (e.g., detemir), long-acting insulin analogues (e.g., insulin, glargine, detemir), and DPP-IV inhibitors (e.g., sitagliptin, vildagliptin) may have a lower risk for weight gain. A new class of GLP-1 agonists (e.g., exenatide, liraglutide) may induce modest weight loss.
Obesity-associated dyslipidemia has been shown to be atherogenic. Abdominal obesity is associated with increases in plasma triglycerides and decreases in HDL cholesterol. The effect of obesity on LDL cholesterol is less clear, but obese individuals have increased atherogenic small, dense LDL particles and elevated levels of apolipoprotein B (Apo B). Increased levels of lipoprotein a (Lpa) are also commonly seen in patients with abdominal obesity.
Hypertension is closely related to abdominal obesity, particularly in younger individuals. Obesity-related hypertension is characterized by sodium retention, increased sympathetic activity and activation of the renin-angiotensin-aldosterone system (RAAS).
Obstructive Sleep Apnea
The presence of obstructive sleep apnea is an important cause of “resistant” hypertension in obese patients and should be formally ruled out in all obese hypertensive patients. Screening for sleep apnea is covered in Chapter 5.
Smoking cessation is a major goal for cardiopulmonary risk management. It is important to recognize that smoking is commonly used as a weight-control measure, particularly in younger women. The fear of weight gain should be acknowledged as a significant obstacle to smoking cessation, but it is less likely to produce negative health consequences than continued smoking.
© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.
The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.
Members of the Canadian Obesity Network can download Best Weight for free.