How are we diagnosing cardiometabolic risk in primary care settings?

Abstract

To assess attitudes, barriers and practices of clinicians in assessing and treating cardiometabolic risk in overweight adults. In 2006, primary care physicians and mid-level practitioners in Montana were surveyed (N=430). 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%). 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.