Depending on the criteria used to define insulin resistance or the metabolic syndrome, approximately one fourth to one third of the adult population (aged 40-70) is insulin resistant. Nearly 47 million people were identified as having the metabolic syndrome when the ATP III criteria were applied to the year 2000 NHANES data in the US population. Clearly, whichever criteria are used, there is a large percentage of the population identified who will be at risk for CVD or type 2 diabetes, or both.
In 1988, Dr Reaven was awarded the Banting Award for his work in insulin resistance. He initially coined the phrase "Syndrome X" to identify the clustering of risk factors highly correlated with insulin resistance and hyperinsulinemia. Since then, this syndrome has been called by many different names and is now more commonly known as the "metabolic syndrome," or insulin resistance and the insulin-resistant syndrome. In addition, many more clinical consequences have been identified over the last 30 years of research. All of this and more have been put together in a new educational publication for healthcare professionals. Entitled "Reducing Cardiovascular Risk in the Insulin Resistant Patient," this new educational project developed by the Preventive Cardiovascular Nurses Association (PCNA) focuses on insulin resistance, the clustering of abnormalities, and the relationship of insulin resistance to clinical consequences such as CVD and type 2 diabetes. This educational piece devotes seven chapters to this important topic and explains how it impacts individuals and what can be done to prevent or reduce the risks associated with this syndrome. The first two chapters provide an overview of the significant role insulin resistance plays as a risk factor for CVD and the pathophysiology involved in the development of clinical outcomes related to insulin resistance such as hypertension, dyslipidemia, type 2 diabetes, and CVD. With this background in place, the next three chapters provide important detailed information on patient care. The first of these three chapters includes a full patient assessment including health history, comprehensive physical examination, and management plan. The next reviews the important role lifestyle changes play in impacting insulin resistance and many of the related consequences, and the last, but certainly not the least, is a comprehensive chapter on pharmacological interventions needed to treat this complex patient in addition to lifestyle changes.
Recognizing the importance of proper billing, we have included this information in the chapter on documentation and communication. Although insulin resistance is a major problem in the adult population, even more alarming is the increasing rate of insulin resistance in the pediatric population. Therefore, we have devoted the final chapter to this topic. Our goal in developing this educational tool is to provide current information about insulin resistance and to offer tools to assess people at greatest risk and provide information on the best treatments to reduce their risk for developing CVD and type 2 diabetes.
This publication will be mailed to all PCNA members in November 2004 as a complimentary supplement to the Nurse Practitioners Prescribing Reference Guide. Continuing education credits will be offered by PCNA. Visit http://www.pcna.net for more information.
Section Description
The Journal of Cardiovascular Nursing is the official journal of the Preventive Cardiovascular Nurses Association. The mission of the Preventive Cardiovascular Nurses Association is to promote nurses as leaders in cardiovascular risk reduction and disease management.