Outcomes of a Multidisciplinary Approach to the Management of the Metabolic Syndrome

Background: Patients with the metabolic syndrome (determined by NCEP ATPIII criteria) are at increased risk for the development of diabetes, cardiovascular disease, and cancer. Objectives: We sought to determine whether treating patients at a dedicated community-based clinic using a multidisciplinary program would result in positive changes in predetermined clinical indicators of the metabolic syndrome. Methods: Patients were referred to the clinic by either family physicians or specialists. They were seen individually by a health care team consisting of a registered dietitian, a registered nurse, a pharmacist, and an endocrinologist. Patients were counselled with regard to lifestyle changes and pharmacotherapy in order to achieve targets for glucose, lipids, blood pressure, and weight. Patients remained on the program for a maximum of 6 months. Results: There were statistically significant changes for the first 76 patients who completed at least 4 of 6 monthly visits. The following parameters decreased: waist circumference 122.4 to 117.9 cm (p ≤ 0.001), systolic blood pressure 140.8 to 130.6 mmHg (p ≤ 0.001), diastolic blood pressure 79.2 to 74.0 mmHg (p ≤ 0.001), fasting blood glucose 9.0 to 8.1 mmol/L (p ≤ 0.001), triglycerides 2.5 to 2.0 mmol/L (p ≤ 0.003), LDL cholesterol 2.6 to 2.2 mmol/L (p ≤ 0.001), TC/HDL ratio 4.5 to 3.9 (p ≤ 0.001), BMI 37.4 to 35.8 kg/m2 (p ≤ 0.001), and HbA1C 7.0 to 6.7% (p ≤ 0.004). There was no change in HDL cholesterol. Conclusion: Our study demonstrates a significant improvement in most parameters of the metabolic syndrome in patients who attended a dedicated 6-month, community-based, multidisciplinary program.