Disease management of the metabolic syndrome in a community: study design and process analysis on baseline data.
BACKGROUND
A comprehensive lifestyle approach is suggested as first-line treatment for the individual features of the metabolic syndrome, but the results in community medicine are usually discouraging. No study has tested the feasibility of an integrated approach between general practitioners (GPs) and specialist centers.


METHODS
We report the process analysis on baseline data of a randomized study based on the integration between GPs, selecting patients on the basis of a pre-defined grid and specific targets, and a specialist center, providing informative material and arranging courses of counseling and cognitive-behavioral therapy, using a shared database. After initial visits by GPs for clinical assessment and motivation to treatment, patients were randomly assigned to: (a) prescriptive diet, managed by GPs; (b) counseling (four group lessons); (c) cognitive-behavioral treatment (12 group lessons), both managed by specialist center. Data of the first 503 subjects were compared with those of 139 cases self-referring to the specialist center for the treatment of obesity.


RESULTS
Subjects enrolled by GPs were more frequently males, had lower obesity grades, and a higher number of features of metabolic syndrome, compared with the control group. Only 10% of subjects randomized to counseling and 27% randomized to behavior declined participation in the intensive treatments; attendance at sessions averaged 90%. GPs were satisfied with their participation and reported that treatments met patients' needs.


CONCLUSIONS
An integrated approach to lifestyle changes between GPs and a specialist center is feasible in the metabolic syndrome and may be cost-effective, considering the high burden of disease.
Melchionda
Nazario
N
Unit of Metabolic Diseases, Alma Mater Studiorum, University of Bologna, Casalecchio di Reno, Bologna, Italy.
Forlani
Gabriele
G
La Rovere
Lucia
L
Argnani
Paola
P
Trevisani
Fausto
F
Zocchi
Donato
D
Savorani
Giandomenico
G
Covezzoli
Anna
A
De Rosa
Marisa
M
Marchesini
Giulio
G