Metabolic syndrome is a cluster of conditions that synergistically increase the 
risk of cardiovascular disease, type 2 diabetes, and premature mortality. The 
components are abdominal obesity, impaired glucose metabolism, dyslipidemia, and 
hypertension. Prediabetes, which is a combination of excess body fat and insulin 
resistance, is considered an underlying etiology of metabolic syndrome. 
Prediabetes manifests as impaired fasting glucose and/or impaired glucose 
tolerance. Impaired fasting glucose is defined as a fasting blood glucose level 
of 100 to 125 mg/dL; impaired glucose tolerance requires a blood glucose level 
of 140 to 199 mg/dL 2 hours after a 75-g oral intake of glucose. In patients 
with prediabetes, the rate of progression to diabetes within 3 years can be 
decreased by approximately 58% with lifestyle modifications. These include 
weight loss through exercise (30 minutes or more of moderate physical activity 
on most, preferably all, days of the week) and dietary modifications. 
Recommended diets are high in fruits, vegetables, whole grains, and fish. 
Consumption of sweetened beverages, including diet soda, should be avoided. For 
patients who do not achieve goals with lifestyle modifications, metformin can be 
considered. Weight loss drugs and bariatric surgery are appropriate for select 
patients. Hypertension and dyslipidemia should be managed according to current 
guidelines.