The Metabolic Syndrome: Lifestyle, Drugs, or Both?

Adrian Cameron, Jonathan Shaw, Paul Zimmet

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The Metabolic Syndrome represents a major public and personal health threat for almost all communities around the world. There is little direct evidence yet available on its prevention and treatment, but evidence from studies on diabetes, obesity and cardiovascular risk factors can be used to shed light on the issue. A series of trials in recent years have studied the prevention of type 2 diabetes, with either lifestyle or pharmacological interventions. Since the participants had impaired glucose tolerance, and most were obese, they are likely to have all had or been at risk of developing the Metabolic Syndrome. Convincing results from a range of ethnic groups in different parts of the world showed a major impact of intensive lifestyle intervention (focusing on weight loss, low-fat, high-fiber diets, and a minimum of 150 minutes of exercise per week) on the incidence of diabetes, which was reduced by up to 60%, despite fairly small amounts of weight loss. In the American DPP study, the in-tensive lifestyle intervention also resulted in a 41% reduction in the incidence of the Metabolic Syndrome. Lifestyle studies have also shown some benefits on the individual components of the Metabolic Syndrome, with reductions in obesity and blood pressure, and improvements in lipid levels. The challenge now is to translate the findings, which have been obtained with the support of intensive research programs, into health care practices, which are affordable, available and effective for the wider community. The translation of these findings into practical solutions will be particularly challenging in the developed world, due to lack of resources and the co-existence of under-and over-nutrition. Data from the pharmacological components of diabetes prevention studies has shown reductions in diabetes incidence ranging from 25% to 56%, using the alpha-glucosidase inhibitor, acarbose, metformin, and the insulin sensitizing agent, troglitazone. Further, ongoing studies of a variety of agents, including ACE inhibitors, angiotensin II receptor blockers, and various oral hypoglycemic drugs will increase our understanding of diabetes prevention, and, importantly, will determine whether diabetes prevention with these agents also leads to reductions in cardiovascular disease.

Original languageEnglish
Title of host publicationThe Metabolic Syndrome at the Beginning of the XXI Century
Subtitle of host publicationA Genetic and Molecular Approach
EditorsManuel Serrano Ríos, Raffaele Carraro, José F. Caro, José A. Gutiérrez Fuentes
Place of PublicationMadrid
Number of pages12
ISBN (Print)8481748927, 9788481748925
Publication statusPublished - 11 Nov 2005
Externally publishedYes

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