METABOLIC HEALTH IN THE TIME OF COVID By Kristin Baier, MD
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our patient returns to clinic for his quarterly check to reassess his hypertension, dyslipidemia and type 2 diabetes mellitus (T2DM.) Over the last few years, you have observed his BMI slowly breaking the threshold into obesity, with an unfavorable waist circumference, hyperglycemia inching toward the need for insulin, triglycerides elevating while high-density lipoproteins stagnate, and blood pressure climbing to the verge of needing another pharmaceutical agent. All of this occurred despite his insistence on compliance with dietary guidelines and trying his best to incorporate more movement into his day through the aches and pains of osteoarthritis. This patient’s situation has become all too familiar for primary care providers and specialists. Despite their best efforts and medications at their fingertips, patients are slipping further into the despair of metabolic disease. Researchers at the University of North Carolina Gillings School of Global and Public Health examined National Health and Nutrition Examination Survey data from 8,721 people in the United States between 2009 and 2016. Data revealed 12.2% of American adults are metabolically healthy — defined as having optimal
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November/December 2020
waist circumference, fasting glucose, high-density lipoprotein, triglycerides and blood pressure. This leaves the remaining 87.8% of the population more vulnerable to developing disease, including type 2 diabetes.1 While we are leading the world in many aspects of medicine, metabolic disease has become our Achilles heel. COVID-19 has brought renewed interest and urgency into successful treatment and prevention of metabolic syndrome. COVID statistics obtained from the CDC clearly show higher morbidity and mortality associated with metabolic disease, specifically diabetes and obesity. The CORONADO study demonstrates that being overweight and obesity are associated with poor early prognosis in patients with T2DM hospitalized for COVID-19.2 Ten percent of these hospitalized patients died within seven days. Sixty-five percent of diabetic patients with COVID-19 admitted to the hospital are men. Another study confirms patients with T2DM are prone to developing severe and critical COVID-19 with poor therapeutic effect.3 Complications of metabolic syndrome prior to COVID have been well established, yet barriers to successful, sustainable treatment and prevention
The “eat less, move more” campaign has been an epic failure as it fails to address the endocrine adaptations and satiety mechanisms that are crucial for weight loss.