Methods ResearcharticleswerelocatedusingtheMEDLINEwithFullText(EBSCO)databaseandPubMed/Medlinedatabasebetweenthefallof2018andsummerof2019.Articleswereassessedtomeetinclusioncriteriasuchas:researchperformedbetween1998-2018ontheUSadultpopulationwithMetS,theUSadultpopulationatriskforMetS,andthenon-USadultpopulationwithoratriskforMetS.Allincludedresearchpertainedtothestudyoflifestyleinterventions,metformininterventions,ormeditationinterventionsandtheirrespectiveeffectsonMetSparameters.
Results
References
Refernces
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Discussion ThegoalofthisreviewwastocompareadjunctivetherapiesforMetSwhichcanbeaddedtothecurrenttreatmentapproachofincreasedexercise,dietmodification,andsmokingcessation.
InstudiesoftheimpactofmeditationonMetSparameters,statisticallysignificantimprovementsinfastingglucosewereshowninbothofthecohortstudieswherethisparameterwasmeasured.
Metformininterventionsshowedrepeatedimprovementinfastingplasmaglucoseandinsulinresistance(measuredbyHOMA-IR)ineachstudywheretheseparametersweremeasured.
Conclusion Theimprovementinfastingglucoseandinsulinresistanceseeninboththemeditationinterventionandmetformininterventionislikelyexplainedbyboththebenefitofthetherapyaswellasthetendencyfortheseparameterstoworsenovertimewithoutanyintervention.Therelationshipbetweendepressivesymptomology,lowmindfulness,andMetSprevalenceshouldbeviewedasanadditionaltreatmentgatewaywhendeterminingtherapeuticoptionsinaspecificpatient.ThelackofsignificantresolutionofMetSinwomenwithmetformintherapyobservedbythelargecohortstudyisasurprisingresult.Thisresultwasnotreflectedinthesmallercohortstudies,howevertheconflictingresultsforceustoquestiontheefficacyofthedruginthefemalepopulation.Overall,thepresenceofMetSinasinglepatientrequiresamultifactorialandtailoredtreatmentapproach.Baselinelaboratoryparameters,gender,anddepressivesymptomologyatbaselineshouldallbeconsideredineachpatientbeforeproceedingwithestablishingatreatmentplantailoredfortheindividual.
Introduction MetabolicSyndrome(MetS)isarapidlygrowinghealthconcernintheUnitedStatesandisestimatedtoimpactmorethan34%ofAmericanadults.1ThecomponentsofMetSincludecentralobesity,dyslipidemia,hypertension,andimpairedglucosemetabolism,specificallythecollectivepresenceofthreeormoreofthesefactorsinasinglepatient.2
PatientswithMetSexhibitanincreasedriskforcardiovasculardisease,typeIIdiabetesmellitus,stroke,andmortality.1
ThecurrenttreatmentrecommendationforadultswithMetSistotargetthemodifiableriskfactorsthatareshowntobeassociatedwithMetS,includingsmoking,sedentarybehavior,andeatingbehavior.2AdditionaladjuncttreatmentoptionsthathavebeenproposedforMetSincludepharmacologicinterventionwithmetformintherapyorpsychologicalinterventionswithmeditationpractices.
Interventions Meditationisanumbrellatermreferringtoanymentalmindfulnesspracticedesignedtoimproveconcentration,insight,orawarenessofthepresentmoment,promoterelaxation,reducestress,settlethemind,achieveastateofincreasedconsciousness,andreduceperceivedsufferingandincreasehappiness.3
Metforminisanoralbiguanidepharmacologicagentusedtoimproveglycemiccontrolinadultpatientswithtype2diabetesmellitusandmayalsobeeffectiveinanumberofotherapplicationssuchastreatmentforMetS,cancer,obesity,nonalcoholicfattyliverdisease(NAFLD),andpolycysticovarysyndrome(PCOS).4
Meditation vs. Metformin in the Management of Metabolic Syndrome
Macey Riese PA-S, Sharon Gentry PA-C, Abigail Allen PA-C
The University of Findlay
1SohlSJ,WallstonKA,WatkinsK,BirdeeGS.YogaforRiskReductionofMetabolicSyndrome:Patient-ReportedOutcomesfromaRandomizedControlledPilotStudy.Evidence-BasedComplementaryAndAlternativeMedicine:Ecam.2016;2016:3094589.https://login.ezproxy.findlay.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=27847524&site=ehost-live.AccessedNovember16,2018
2GuyotE,BaudryJ,HercbergS,GalanP,Kesse-GuyotE,PéneauS.MindfulnessIsAssociatedwiththeMetabolicSyndromeamongIndividualswithaDepressiveSymptomatology.Nutrients.2018;10(2).doi:10.3390/nu10020232.https://eds-b-ebscohost-com.ezproxy.findlay.edu/ehost/pdfviewer/pdfviewer?vid=10&sid=a443b3d1-df90-48c5-8eed-038e79867671%40pdc-v-sessmgr02.AccessedNovember16,2018.3MeditationandCardiovascularRiskReduction:AScientificStatementFromtheAmericanHeartAssociation.JAmHeartAssoc.2019;8(2):e004176.Published2019Jan15.doi:10.1161/JAHA.117.004176.AccessedMay21,2019.4ZhouJ,MasseyS,StoryD,LiL.Metformin:AnOldDrugwithNewApplications.IntJMolSci.2018;19(10):2863.Published2018Sep21.doi:10.3390/ijms19102863.AccessedMay21,2019.
5DaubenmierJ,MoranPJ,KristellerJ,etal.Effectsofamindfulness-basedweightlossinterventioninadultswithobesity:Arandomizedclinicaltrial.Obesity(SilverSpring,Md).2016;24(4):794-804.doi:10.1002/oby.21396.https://journals-ohiolink-edu.ezproxy.findlay.edu/pg_99?213010949113380::NO::P99_ENTITY_ID,P99_ENTITY_TYPE36844511,MAIN_FILE&cs=3gq8rikel0jMHkAG7eRvI8yDeO3-m2mpJfT3oLbOHTyo08zI58maq3T7LDoh9z2_rF2J8zxZ2_coV1YaEQwklWwAccessedNovember16,2018.6Paul-LabradorM,PolkD,DwyerJH,etal.Effectsofarandomizedcontrolledtrialoftranscendentalmeditationoncomponentsofthemetabolicsyndromeinsubjectswithcoronaryheartdisease.ArchivesOfInternalMedicine.2006;166(11):1218-1224.https://login.ezproxy.findlay.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=16772250&site=ehost-live.AccessedNovember16,2018.
7VitaleC,MercuroG,CornoldiA,FiniM,VolterraniM,RosanoGMC.Metforminimprovesendothelialfunctioninpatientswithmetabolicsyndrome.JournalOfInternalMedicine.2005;258(3):250-256.https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=16115299&site=ehost-live.AccessedMay21,2019.
8LimaLM,WiernspergerN,Kraemer-AguiarLG,BouskelaE.Short-termtreatmentwithmetforminimprovesthecardiovascularriskprofileinfirst-degreerelativesofsubjectswithtype2diabetesmellituswhohaveametabolicsyndromeandnormalglucosetolerancewithoutchangesinC-reactiveproteinorfibrinogen.Clinics(SaoPaulo).2009;64(5):415–420.doi:10.1590/S1807-59322009000500008.AccessedMay21,2019.9BulcãoC,GiuffridaFMA,Ribeiro-FilhoFF,FerreiraSRG.Arethebeneficialcardiovasculareffectsofsimvastatinandmetforminalsoassociatedwithahormone-dependentmechanismimprovinginsulinsensitivity?BrazilianJournalOfMedicalAndBiologicalResearch=RevistaBrasileiraDePesquisasMedicasEBiologicas.2007;40(2):229-235.https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=17273659&site=ehost-live.AccessedMay21,2019.
Table 5. Change in Fasting Glucose by Study Intervention
Study Type Participants Data Time
Mindfulness intervention (Article 1)5
100 obese adults without DM (28% with MetS at baseline
-4.1mg/dL vs control 18 months
Mindfulness Intervention (Article 2)6
84 adults with heart disease at baseline -6mg/dL vs control 16 weeks
Metformin intervention (Article 7)7
32 adults with MetS at baseline -16mg/dL vs control 12 weeks
Metformin intervention (Article 8)8
16 adults with MetS parameters at baseline
-4.5mg/dL vs control 16.5 weeks
Metformin intervention (Article 9)9
21 overweight or obese adult females with or without impaired fasting glucose at baseline
-5.8mg/dL vs simvastatin group
16 weeks
Table 6. Change in HOMA-IR by Study Intervention
Study Type Participants Data Time
Mindfulness Intervention (Article 1)5
100 obese adults without DM (28% with MetS at baseline
Adjusted ΔHOMA-IR -0.77
12 months
Mindfulness Intervention (Article 2)6
84 adults with heart disease at baseline
Adjusted ΔHOMA-IR -0.75
16 weeks
Metformin intervention (Article 7)7
32 adults with MetS at baseline Adjusted ΔHOMA-IR -0.89
12 weeks
Metformin intervention (Article 9)9
21 female adults Adjusted ΔHOMA-IR -1.9
16 weeks
Table 7. Effect on HDL by Study Intervention
Study Type Participants Data Time
Mindfulness intervention (Article 1)5
100 obese adults without DM (28% with MetS at baseline
Δ2.9mg/dL vs control 18 months
Mindfulness intervention (Article 2)6
84 adults with heart disease at baseline No statistically significant change noted
16 weeks
Metformin intervention (Article 7)7
32 adults with MetS at baseline No statistically significant change noted
12 weeks
Metformin intervention (Article 8)8
16 adults with MetS parameters at baseline
+7.0mg/dL 16.5 weeks
Metformin intervention (Article 9)9
21 overweight or obese female adults No statistically significant change noted
16 weeks