Metabolic syndrome nursing issues

The core issue in metabolic syndrome care has never been the control of single indicators such as blood sugar, blood pressure, blood lipids, and weight, but the maintenance of long-term behavioral compliance of patients, the balance of care priorities for multiple comorbidities, and the adaptation of standardized clinical pathways to individualized life scenarios. This is the most intuitive conclusion I have come to after working in a community chronic disease management position for 5 years and handling more than 300 patients.

Data in the 2024 "China Metabolic Syndrome Prevention and Treatment Guidelines" show that the prevalence of metabolic syndrome in adults in my country has reached 33.9%, but the long-term care compliance of patients is less than 30%. The core problem is that many plans are completely divorced from the patients' real life scenarios. Last week, I came across Uncle Zhang’s case in the follow-up ledger. He is a 52-year-old taxi driver with a waist circumference of 96cm, a fasting blood sugar of 6.8mmol/L, a blood pressure of 145/95mmHg, and triglycerides that are twice as high as the standard. It is a perfect case of metabolic syndrome. At first, we followed the routine care plan of the endocrinology department, requiring him to walk 10,000 steps a day, replace his staple food with whole grains, and consume no more than 5g of salt every day. However, after a follow-up visit half a month later, his blood pressure had risen to 150/100mmHg. When we asked, we found out that in order to make up for the number of steps, he walked for an hour after picking up the car every day. He was too tired to eat and suffered from insomnia at night, which was counterproductive.

Interestingly, the clinical thinking of different departments differs greatly in terms of the nursing priorities for this type of patients: the nursing logic of the endocrinology department is generally to control sugar and reduce waist circumference first, believing that insulin resistance is the core cause; the cardiovascular nursing team will give priority to monitoring blood pressure and low-density lipoprotein, after all, the risk of cardiovascular events in patients with metabolic syndrome is 2-3 times that of the general population; and the nursing thinking of our general department is softer, usually looking for a small habit that is easiest for the patient to change, and will not give a bunch of bans at the beginning. Each of these three types of programs is supported by data. A 2023 survey by the Chronic Disease Management Branch of the Chinese Medical Association showed that for patients who have already suffered target organ damage, the one-year adverse event rate of the program that prioritizes cardiovascular index control is 12% lower than that of the program that prioritizes sugar control; but for first-time patients who have no obvious symptoms, the program that starts with minor adjustments to lifestyle habits has a compliance rate more than twice that of the program that strictly controls indicators. At present, the academic community has not reached a unified conclusion. In clinical practice, we all choose according to needs, and there is no absolute right or wrong.

Don't mention it, I have encountered a case that goes against common sense before. A 28-year-old Internet programmer has a BMI of only 22.7, a completely normal weight, with a waist circumference of 82cm, and fasting blood sugar, triglycerides, and blood pressure all exceeding the standard. He is a typical "lean metabolic syndrome". He has very strong self-discipline and can strictly follow a low-GI diet. He also goes to the gym three days a week, working on projects until early in the morning every day and sleeping less than five hours. At the beginning, we asked him to adjust his diet according to the regular plan, but after three months, his indicators did not change at all. Later, a colleague from the nutrition department reminded him to ensure that he sleeps for 6 hours a day and does not have to deliberately eat and drink, even if he drinks a cup of milk tea occasionally. As a result, after two months of adjustment, his blood lipids dropped by half. This incident also reminded me, don’t always focus on those test indicators. Invisible things such as cortisol, sleep, and mood have a greater impact on metabolism than what you eat.

There is another controversial nursing direction now, which is the promotion of "metabolic flexibility" training. One group of scholars believes that patients do not need to eat bland and healthy meals all year round. Instead, they can have 1-2 "relaxation meals" per week, including their favorite hot pot or milk tea. As long as the overall intake does not exceed the standard, it can reduce the psychological burden and improve long-term compliance. However, the other group of endocrinologists are firmly opposed, believing that such intermittent high-sugar and high-oil intake will disrupt blood sugar homeostasis and aggravate insulin resistance. We have conducted a small-scale comparison in our community. Half of 20 sweet-toothed middle-aged women were given a strict sugar control plan, and half were allowed to eat cake once a week. After half a year, the compliance rate of the group allowed to eat cake was 20% higher than that of the group with strict sugar control. Of course, this sample size is too small to explain anything. But in practice, for female patients who are already prone to feeling guilty, looser standards are easier to adhere to.

In fact, the longer I work in this field, the more I feel that there is no profound truth in the care of metabolic syndrome. We often tell new nurses, don’t read the rules and regulations in the health manual to the patient as soon as they come in. Sit down and chat with them for 10 minutes. Ask them whether they usually work in the office or go out to work, whether they cook their own meals or order takeout, and whether there are any favorite foods that they are reluctant to give up. We had a patient who wanted to eat pickled radishes all the time. We tried to stop him from saying that life was boring, but we didn't force him. We just asked him to soak the food in water for 10 minutes before eating, and then reduce the amount of salt he consumed every day. Later, his blood pressure gradually stabilized.

After all, no matter how good the care plan is, it will be in vain if the patient cannot persist with it.