Barry McLean MD, PhD treats many patients for metabolic syndrome, and he seeks to address it before it becomes a more serious condition which cannot be cured. Unfortunately, many of the newest treatments are not always covered by insurance.
"Metabolic syndrome is quite common," he said. "It's generally associated with people who are overweight which gives them a predisposition to develop Type 2 diabetes, and they frequently have other problems as well. It is a potentially deadly situation because it can lead to progressive heart disease and other complications. The syndrome is typically recognized by the presence of central or abdominal obesity."
McLean encourages general practitioners and internists to screen for metabolic syndrome in all their patients. "If you identify these people early, you are able to emphasize diet and exercise to delay the development and prevent many of the complications. You can actually prevent diabetes and heart disease," he said.
Family history is a key indicator. "Pay very close attention to family history," McLean said. "If your family members had diabetes or high cholesterol, you may be at risk to develop those as well. Metabolic syndrome is something you can cure and prevent if you know about it and understand what you can do."
McLean said there are several new medications that are beneficial for treating the syndrome.
One is the anti-diabetic drug Metformin. "Technically it's a treatment for Type 2 diabetes, but you can begin it as a preventive drug for patients with metabolic syndrome," he said. "It does help them lose weight and change their metabolism, so they are less likely to develop full-blown diabetes."
Another treatment option is the class of GLP-1 inhibitors. "These drugs, such as Ozempic and Trulicity, are injectable," McLean said. "You give yourself a shot once a week and reverse the pathology of the metabolic syndrome. So you can use them for metabolic syndrome and to treat excessive weight as well. Wegovy is another brand, but it is sold specifically for weight loss. People who are overweight but don't have any other indications of metabolic syndrome can use it.
"Unfortunately, the GLP-1 inhibitors are expensive and insurance doesn't always provide the kind of coverage they should. You have to go through an approval process to justify why you want to do that. Many times new drugs are approved and put on the market, but they aren't covered until insurers are sure they will work. If you could start someone on these medicines without worrying if they'll be covered or not, we'd all be better off. You might go through the whole process with a request that looks like a million dollars and then be told they don't cover it.
"It's getting easier to get coverage for Ozempic, but it's almost impossible to get the drug for weight loss approved in Alabama. We have several hundred patients who should be covered, but we have only gotten it approved for one or two."
That's one of the reasons McLean encourages his patients to modify their diet and increase exercise to address metabolic syndrome, if possible, rather than seek to treat it with medications. "A lot of people eat fast food, but unfortunately, fast is fattening," he said. "We live in such a hurried society that many people don't take the time to eat a healthy diet. Having a regular exercise plan is also very preventative for these patients. We try to work out a schedule where they walk, say, three times a week." He said jogging, light weights, stationary bikes are all viable alternatives as well.
He admits that convincing patients to make these changes is not easy. "Unfortunately, the best I can do is provide the information and tell them they are at high risk to develop something significant," he said. "I stress it will be in their best interest to reverse that process as soon as possible."
"I always remind my patients that unlike diabetes and heart disease, metabolic syndrome can be cured. Whether it's treated by diet and exercise or medication, it's important to address this condition early. It really is beneficial for them to know about this, to know what they can do about it, and to know if they make these changes, they are much less likely to develop problems down the road."
