Metabolic syndrome nursing issues

The core issue of metabolic syndrome care is by no means a single control of a certain metabolic indicator. The essence is to solve the three common pain points of "low patient behavioral compliance, difficulty in collaborative management of multiple indicators, and blurred boundaries of individualized intervention." All other operational-level issues are basically specific manifestations derived from these three core pain points.

I just treated a 42-year-old middle-level business executive named Zhang last month. When he was diagnosed with metabolic syndrome, his abdominal circumference was 97cm, his fasting blood sugar was 6.8mmol/L, his blood pressure was hovering at 145/95mmHg, and his triglycerides were 2 times higher than the normal value. However, he didn’t take it seriously at all. He said he didn’t feel any discomfort other than occasional sleepiness.

Regarding compliance intervention, there have always been two completely different ideas in the industry: one favors "hard constraints", advocating that patients should clearly define the total daily caloric intake, exercise duration, and review cycles. If they cannot complete it, the plan must be adjusted. This is suitable for patients with urgent health needs and strong self-discipline.； The other group prefers "soft awakening" and does not first mention requirements such as weight loss and target control that can easily cause resistance. Instead, it starts with the small details that patients care about - for example, Mr. Zhang complained that he easily fell asleep during meetings and the hair gap on the top of his head was getting wider and wider. I first made him two small requests: to replace sugary carbonated drinks with sugar-free oolong tea when socializing, and to go to bed 15 minutes earlier every day, so that he did not have to quit drinking immediately or run 5 kilometers. Don't tell me, he felt no pressure to implement it. After persisting for two weeks, he said that he felt more energetic during the afternoon meeting. He took the initiative to ask me what else I could change next, and his compliance improved immediately.

After solving the problem of compliance, the next pitfall that is most likely to be stepped on is "treating a headache and treating a pain in the head and feet." Many patients and even new nurses think that if their blood pressure is high, they should put less salt, and if their blood sugar is high, they should eat less sugar. They can be controlled separately. In fact, this is not the case at all. There was a 62-year-old aunt who listened to the advice of sugar control and ate boiled vegetables every day and did not dare to touch rice. As a result, after 3 months, her blood sugar dropped a little, her blood pressure was still stuck at 150/90mmHg, and she did not lose a pound or two of weight. When I asked, I found out that she thought boiled vegetables were tasteless and added two tablespoons of pickled mustard to every meal. During the day, her sodium intake exceeded the standard by three times, which actually aggravated her insulin resistance. No matter how light she ate, it was useless. Interestingly, regarding the path of multi-index management, Corey has previously conducted controlled trials: For patients with traditional step-by-step intervention (control blood pressure for 3 months first and then adjust blood sugar and blood lipids), only 41% of the patients met the standard in half a year. However, for patients who adopted collaborative intervention, while adjusting the sodium content and GI value of the diet, combined with moderate-intensity exercise three times a week, the half-year standard compliance rate could reach 73%, and the gap was very obvious.

The last thing that cannot be avoided is how to grasp the "degree" of individualized intervention. Many people in the industry have previously believed that patients with metabolic syndrome must completely adjust their lifestyle if they want to achieve effective results. Failure to do so means "poor compliance." However, after actually contacting so many patients, you will know that most people have their own insufficiency: those who work in sales have to socialize every day, and those who work in the Internet have to work overtime until 10 o'clock every day. How can they have so much time to cook for themselves and go to the gym every day? If we force them to eat and exercise on the same schedule as retired people, it will not be implemented at all. Last year, I managed a 28-year-old Internet salesman. He ate out for takeout or dined with customers at least 4 days a week. I didn’t list any healthy recipes that he must eat, but gave him a few simple rules: Prioritize takeout from restaurants with steamed or boiled options. Eat only half of the rice. No matter what social activities, pick up a chopstick of vegetables before drinking wine. If you don’t have time to run, go home from get off work and do 3 sets of squats against the wall for 1 minute each. He followed it for three months, and his waist circumference dropped by 6cm, and his triglycerides dropped from 2.7mmol/L to 1.4mmol/L. Even he found it incredible.

Having been doing metabolic care for almost 8 years, my biggest feeling is that many times we nurses fall into the misunderstanding of "index first". We always feel that patients must reduce all indicators to normal values ​​for care to be effective. But in fact, metabolic syndrome is a chronic disease tied to lifestyle. What we have to do is never to turn patients into "health models" who are divorced from normal life, but to help them find the easiest adjustment method to adhere to within the existing rhythm of life. Even if you just drink one less cup of milk tea and walk 10 minutes more, as long as you stick to it for a long time, it will be more effective than setting a bunch of goals that are simply impossible.

Of course, there are still many controversial aspects in the care of metabolic syndrome: for example, for patients who have not significantly improved after 1-2 months of lifestyle modification, different experts have different opinions on whether to initiate drug intervention as early as possible.； For adolescent patients with metabolic syndrome, whether the scale of intervention is different from that for adults, more clinical data are still being accumulated. But no matter how technology and consensus change, the core of nursing care will always revolve around the patient, not around cold indicators. This will never change.