Enlightenment and reflections on metabolic syndrome nursing work

Regarding the clinical care of metabolic syndrome, the core conclusion at this stage is not to strictly apply standardized guideline control indicators, but to follow the path of "layered adaptation + full-scenario penetration" - on the premise of maintaining the bottom line of medical safety, priority is given to adjusting intervention plans to match patients' actual life scenarios, so that the effects of disease management can be truly implemented.

I just met a 42-year-old Internet programmer in the clinic last week. He has abdominal obesity, fasting blood sugar of 6.8mmol/L, triglycerides twice the standard, and blood pressure that fluctuates around 140/90mmHg all year round. According to the standard guidelines, he was prescribed a low-GI diet and 150 minutes of moderate-intensity exercise per week. After turning two pages, he smiled bitterly: "Sister nurse, I make 996 a week and rely on takeout for meals. It's already 11 o'clock when I get home from get off work. How can I have time to do this?" ”I changed the plan for him: he didn’t need to cook anything special, put half the salt and sugar in the takeout notes, replaced his afternoon milk tea with unsweetened soy milk and a hard-boiled egg, got off the subway one stop earlier and walked to and from work. Calculating, he still had 20 minutes of activity every day, so he didn’t need to spare any extra time. He came for a follow-up checkup last month. His triglycerides dropped by nearly half, his blood pressure was stable at around 130/80mmHg, and his waist circumference was 3 centimeters smaller.

In fact, this situation is too common in clinical practice. The academic community has been arguing for a long time over the standards for formulating nursing plans. One group is the "indicator-first group", which advocates strict compliance with the threshold requirements of the "China Guidelines for the Prevention and Treatment of Type 2 Diabetes" and "China Guidelines for the Prevention and Treatment of Hypertension". The four core indicators of sugar, fat, blood pressure, and waist circumference must meet the standards. The evidence-based evidence is the most sufficient and plays an important role in reducing the risk of long-term complications. It has been verified by a large number of studies, but the shortcomings are also obvious: survey data from the Endocrinology Branch of the Chinese Medical Association in 2023 showed that the compliance rate of metabolic syndrome patients who completely followed the standardized protocol was only 27.6%, and most people gave up after less than 3 months. The other school is the "behavior-first school", which advocates that the target requirements should not be stuck first, and start with the smallest behavioral changes that patients can make, such as giving up the habit of drinking milk tea every day, and halving the nightly snacks every night. The advantage is that patients have high acceptance and the compliance performance can be improved to more than 60%. However, many scholars have questioned: If the target requirements are relaxed for a long time, will the potential risk of cardiovascular and cerebrovascular accidents be increased?

To be honest, I used to be obsessed with the guidelines and the plans I gave patients were extremely strict. It wasn’t until I met retired Aunt Zhang that I changed my mind. She has degenerative disease in her knees. I asked her to walk 10,000 steps a day as required. After walking for a week, she was in so much pain that she couldn't go downstairs. She completely broke the pot and the medicine didn't taste good. Later, I changed her exercise plan to her favorite square fan dance at home for 15 minutes every day. She also took an extra 10 minutes of detours when shopping for groceries, so she didn’t have to force the steps. She persisted very well. In half a year, her waist circumference dropped by 5 centimeters, her blood pressure stabilized within the normal range, and she didn’t even suffer from the old problem of knee pain. It's a bit like charging a mobile phone. Some people's "interface" does not support 120W fast charging. If you have to force it in, it will only damage the battery. Although slow charging is slow, it can actually charge the battery, which is better than plugging it in and out and never being able to charge it.

A mistake that many nursing staff still make is that they always tell patients correct nonsense like "less oil, less salt and more exercise". You have to tell them exactly what to do to make it effective. For example, if you just say less oil, he doesn’t know that the amount of oil used in the spicy hotpot he often eats is enough to meet the health requirements for 3 days. If you tell him, "Next time when ordering the hotpot, make sure to replenish the water, or only add one-third of the oil." This is practical guidance.

Don't tell me, the "Metabolism Peer Group" organized by our community health service center last year really balanced the disputes between the two factions. That is to gather metabolic syndrome patients in the same community into a small group of seven or eight people, and gather offline once a week. The nurse will first test everyone's indicators and draw a clear safety bottom line: for example, blood pressure cannot exceed 150/100mmHg, and fasting blood sugar cannot exceed 7mmol/L. If it exceeds, medication must be adjusted in time, and everyone can give advice on the remaining behavioral adjustments. Some people have replaced the cigarettes they have smoked for more than ten years with sugar-free mints. Some people have replaced lying on the sofa after dinner with going downstairs to walk their dogs for 20 minutes. There is also a restaurant owner who has changed his signature dishes to low-salt recipes. Even his customers praised them for being more delicious. After half a year, 80% of the people in the group have improved their indicators, and the compliance rate is nearly 60% higher than that of individual telephone follow-up.

After working in chronic disease care for almost ten years, my biggest feeling now is that what we face is never a bunch of rising arrows and numbers, but living people with their own work rhythms, living habits, and even appetites. No matter how good the guide is, it will be useless if it does not fall into his daily life. In the final analysis, the battle for metabolic syndrome care is not about whose plan is more standard, but who can truly stand from the patient's perspective and help him find a lifestyle that is not stressful and can be sustained for a long time - after all, no one is willing to make their life miserable just for a few indicators, right?