How are we diagnosing cardiometabolic risk in primary care settings?

Prim Care Diabetes. 2009 Feb;3(1):29-35. doi: 10.1016/j.pcd.2008.12.002. Epub 2009 Jan 19.

Abstract

Aims: To assess attitudes, barriers and practices of clinicians in assessing and treating cardiometabolic risk in overweight adults.

Methods: In 2006, primary care physicians and mid-level practitioners in Montana were surveyed (N=430).

Results: Most primary care clinicians (95%) recognized the clinical benefit of weight loss, but many cited patient motivation (87%), lack of support services (61%), and lack of time (58%) as barriers. Over 80% identified obesity, hypertension, abnormal lipids, history of gestational diabetes, and family history as indications for diabetes screening. Most clinicians used fasting glucose (89%), random glucose (58%), and A1c (42%) as initial screens for diabetes. To confirm the diagnosis, the majority of respondents used A1c testing (80%) or fasting glucose (64%). Approximately one-quarter used the diagnosis pre-diabetes (26%), but just over half (52%) used alternative diagnoses of glucose intolerance. Sixty-five percent used the diagnosis of metabolic syndrome. Of those using metabolic syndrome, mid-level practitioners were more likely than physicians to assess waist circumference (49% vs. 63%).

Conclusions: Despite citing significant barriers, clinicians routinely assessed cardiometabolic risk with diabetes screening, but relatively few reported using the diagnosis pre-diabetes. Metabolic syndrome was used commonly to diagnose overweight adults at risk for diabetes and cardiovascular disease.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Attitude of Health Personnel
  • Biomarkers / blood
  • Blood Glucose / metabolism
  • Body Mass Index
  • Cardiovascular Diseases / economics
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / prevention & control
  • Counseling
  • Diabetes Mellitus, Type 2 / diagnosis*
  • Diabetes Mellitus, Type 2 / economics
  • Diabetes Mellitus, Type 2 / etiology
  • Diabetes Mellitus, Type 2 / therapy
  • Female
  • Glucose Tolerance Test
  • Glycated Hemoglobin A / metabolism
  • Health Care Surveys
  • Health Knowledge, Attitudes, Practice
  • Health Services Accessibility
  • Humans
  • Insurance, Health, Reimbursement
  • Male
  • Metabolic Syndrome / diagnosis*
  • Metabolic Syndrome / economics
  • Metabolic Syndrome / etiology
  • Metabolic Syndrome / therapy
  • Middle Aged
  • Montana
  • Motivation
  • Overweight / complications*
  • Overweight / economics
  • Overweight / therapy
  • Patient Acceptance of Health Care
  • Practice Patterns, Physicians'*
  • Prediabetic State / diagnosis*
  • Prediabetic State / economics
  • Prediabetic State / etiology
  • Prediabetic State / therapy
  • Predictive Value of Tests
  • Primary Health Care* / economics
  • Risk Assessment
  • Risk Factors
  • Surveys and Questionnaires
  • Waist Circumference

Substances

  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human