Overview

Metabolic Syndrome

Metabolic syndrome is a disorder of energy utilization and storage.  One quarter of the world’s adult population has metabolic syndrome.  It manifests when at least three metabolic risk factors are found in a single individual. These metabolic factors include abdominal fat, insulin resistance, hypertension (high blood pressure), high serum triglycerides, and low high-density cholesterol (HDL) levels.  Metabolic syndrome is not a disease itself, but people with metabolic syndrome are much more likely to develop cardiovascular disease, stroke, or type 2 diabetes.

Diabetes: The Global Epidemic

An astonishing 382 million people worldwide have diabetes (IDF Atlas 6th Edition, International Diabetes Federation, 2013).  Diabetes is one of the most challenging health problems of the 21st century, with USD 548 billion dollars spent on diabetes-related health care in 2013 (11% of total adult health care expenditure).  The major complications associated with chronic diabetes include hypertension, heart disease and stroke, diabetic kidney disease, neuropathy, and blindness.

Type 2 diabetes (T2D) is primarily a disease of insufficient glucose control leading to hyperglycemia (high blood glucose).  Insufficient glucose control is a result of insulin resistance where insulin is unable to effectively trigger the uptake of glucose from the blood into cells.  As a result, type 2 diabetic patients struggle, by having insulin resistance, to achieve proper glucose control (as measured by HbA1c - an indicator of how well blood glucose levels have been controlled over several months).  T2D is prevalent in approximately 90% of all diabetic patients.  

Type 1 diabetes (T1D) is an autoimmune disease where the immune system attacks and depletes insulin producing beta cells within the pancreas.  As a result, supplementation with exogenous insulin is required on a regular basis for glucose control.   Approximately 5-10% of all diabetic patients have T1D.

Complications of diabetes arise in part from endothelial dysfunction.  The endothelium, a thin layer of cells on the interior surface of blood and lymphatic vessels, plays a critical role in the normal physiological regulation of vasodilation, blood clotting, platelet aggregation, inflammation, and tissue repair.  Chronic hyperglycemia and oxidative stress impairs endothelium function leading to microvascular damage.  Progressive damage eventually advances to diabetic complications such as hypertension, heart disease and stroke, diabetic kidney disease, neuropathy, and blindness.

Chronic Kidney Disease

Chronic kidney disease (CKD) is the gradual loss of kidney function and damage to the kidneys. The kidneys play a critical physiological role by continually filtering the blood to remove waste products and excess fluid from the body into urine. CKD is a slow, progressive disease usually displaying no symptoms until the very late stages when one begins to feel ill. At end-stage renal disease (ESRD) the kidneys fail completely, requiring dialysis or kidney transplantation to maintain life.

CKD is primarily caused by high blood pressure and diabetes. The National Kidney Foundation estimates 26 million Americans have CKD.  Approximately 40% of CKD is caused by diabetes and is referred to as diabetic kidney disease. Medicare expenditures are approximately USD 45.5 billion for CKD (24.5 billion for those with diabetes) and USD 34.3 billion for ESRD (2013 USRDS Annual Data Report), indicating that early diagnosis and prevention is a major priority.