meditation vs. metformin in the management of metabolic syndrome · 2020-04-27 · syndrome...

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