title: How are we diagnosing cardiometabolic risk in primary care settings?
abstract: OBJECTIVE
  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.
authors.affiliation: Asthma, Cardiovascular Health, and Diabetes Section, Chronic Disease Prevention and Health Promotion Bureau, Montana Department of Public Health and Human Services, Helena, MT 59620-2951, USA.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Gohdes
authors.forename: Helen
authors.initials: H
authors.lastname: Amundson
authors.forename: Carrie S
authors.initials: CS
authors.lastname: Oser
authors.forename: Steven D
authors.initials: SD
authors.lastname: Helgerson
authors.forename: Todd S
authors.initials: TS
authors.lastname: Harwell
mesh_terms: D001291:Attitude of Health Personnel; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000191:economics / Q000209:etiology* / Q000517:prevention & control; D003376:Counseling; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000191:economics / Q000209:etiology / Q000628:therapy; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis* / Q000191:economics / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D009009:Montana; D009042:Motivation; D050177:Overweight / Q000150:complications* / Q000191:economics / Q000628:therapy; D010342:Patient Acceptance of Health Care; D010818:Practice Patterns, Physicians'; D011236:Prediabetic State / Q000175:diagnosis* / Q000191:economics / Q000209:etiology / Q000628:therapy; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000191:economics; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055105:Waist Circumference
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human