Page 512 - Nutrition Essentials for Nursing Practice

500 U N I T 3 Nutrition in Clinical Practice

Metabolic Syndrome: Box 19.1 RISK FACTORS FOR TYPE 2 DIABETES
a clustering of inter-
related risk factors that ■ Ն45 years of age
include hypertension, ■ Overweight (BMI Ն23 kg/m2 in Asian Americans; Ն26 kg/m2 in Pacific Islanders,
low high-density
lipoprotein (HDL) Ն25 kg/m2 all others)
cholesterol, high ■ First-degree relative with diabetes
triglycerides levels, ■ Physically inactive or exercises less than three times per week
and elevated serum ■ Member of high-risk ethnic group: African American, Latino, Native American, Asian
glucose; central or
abdominal obesity, as American, Pacific Islander
indicated by waist ■ Previously identified with prediabetes such as impaired fasting glucose or impaired
circumference, is often
an additional criterion. glucose tolerance
■ History of gestational diabetes or giving birth to a baby weighing Ͼ9 pounds
■ Hypertensive
■ HDL Ͻ35 mg/dL and/or triglyceride level Ն250 mg/dL
■ Acanthosis nigricans

Source: National Diabetes Education Program. (n.d.). Diabetes risk factors. Available at http://ndep.nih.gov/
am-i-at-risk/DiabetesRiskFactors.aspx. Accessed 6/18/2012.

with the risk of cardiovascular disease. This cluster of risk factors is known as the metabolic
syndrome (MetS). People with MetS are approximately five times as likely to develop dia-
betes as those without MetS, and their risk of heart disease is doubled (Alberti et al., 2009;
Grundy, 2008). The progression of prediabetes to diabetes is not inevitable. Recent clinical
trials have demonstrated that lifestyle modification—namely, modest weight loss, moder-
ate physical activity, and a healthy diet—is the most effective tool in preventing or delay-
ing type 2 diabetes (Ahmad and Crandall, 2010). Interventions that can reverse impaired
glucose tolerance early in its course may be the key to preventing long-term complications
of diabetes.

Gestational Diabetes

Gestational diabetes mellitus (GDM) is hyperglycemia that develops during pregnancy, usu-
ally around the 24th week of gestation. Women who meet the standard criteria for diabetes
at their first prenatal visit are diagnosed with overt diabetes, not GDM. Approximately 7%
of pregnancies are complicated by GDM (Bantle et al., 2008).

Diabetes increases risks in mother and infant. It increases the risk of preeclampsia, cae-
sarean delivery, and fetal macrosomia and also the risk of hypertension and diabetes after
pregnancy (Catalano, Huston, Amini, and Kalhan, 1999). Some studies show that as many
as 70% of women who develop GDM will develop type 2 diabetes within 10 years after
delivery (Fowler, 2010). GDM increases the risk of newborn death, stillbirth, and infant
hypoglycemia in the days after delivery.

Women who fulfill all of the following criteria for low GDM risk do not need to be
screened for GDM (American Diabetes Association [ADA], 2010):

■ Age younger than 25 years old
■ Normal body weight
■ No first-degree relative with diabetes
■ No personal history of abnormal glucose metabolism
■ No history of poor obstetric outcome