Pharmacological Management of Metabolic Syndrome in Crisis Settings: A Narrative Review and Three-Axis Model

Metabolic syndrome (MetS) is a multifactorial condition with rising global prevalence and significant long-term health risks. In emergency contexts such as wartime, MetS management becomes increasingly complex due to disrupted healthcare access, limited drug availability, and heightened psycho-emotional stress. This narrative review synthesizes current evidence on pharmacological strategies for MetS, focusing on three widely used agents, metformin, alpha-lipoic acid (ALA), and glucagon-like peptide-1 (GLP-1) receptor agonists, and introduces a three-axis model to address treatment barriers. Seventy-eight peer-reviewed publications from 2015 to 2025 were thematically analyzed to assess the therapeutic efficacy, safety, and feasibility of metformin, ALA, and GLP-1 receptor agonists. These agents demonstrate complementary mechanisms targeting insulin resistance, oxidative stress, and cardiometabolic risk factors with favorable safety profiles and relatively high availability. In constrained settings, pharmacological management must prioritize feasibility, simplicity, and continuity of care. Strategies such as avoiding overlapping mechanisms, integrating lifestyle interventions, and leveraging telemedicine are essential. The proposed three-axis model provides a practical tool for clinicians to identify and address barriers related to physicians, drugs, and patients, thereby improving personalized therapy planning. It emphasizes the importance of tailored care, therapeutic sequencing, drug bioavailability, and patient adherence, especially in situations of social instability. This review stresses the need for multidisciplinary approaches to MetS treatment, going beyond pharmacology to include systemic resilience and patient-centered care.