Transcript Gout - University of Ottawa

The use of hospital pharmacy profiles to
identify patients with metabolic syndrome
and their history of nutrition intervention
from a registered dietitian
Presented by:
Simon Leung, Dietetic Intern
July 17, 2008
Outline
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Metabolic Syndrome Overview
Problem/Research Questions
Methods
Results
Challenges
Future Research
Conclusions
Acknowledgements
Metabolic Syndrome Overview
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A cluster of metabolic
risk factors that:
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↑ risk of CVD ~2-fold
↑ risk of Type-2 diabetes
development ~5-fold
Prevalence in North
America:
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Approximately ~25%
Characteristics of the Metabolic
Syndrome
Abdominal obesity
Diabetes
Glucose intolerance/
Insulin resistance
CVD
Hypertension
Atherogenic dyslipidemia
Adapted from National Cholesterol Educational Program (NCEP), Adult Treatment Panel (ATP) III; 2001.
Slide source: www.obesityonline.org
International Diabetes Federation (IDF)
Definition of Metabolic Syndrome
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Pre-requisite:
Central (abdominal) obesity:
 American: male, ≥ 102 cm; female, ≥ 88 cm
Plus 2 of any of the following factors:
Raised fasting blood glucose:
 ≥ 5.6 mmol/L or previously diagnosed type 2 diabetes
Raised triglycerides:
 ≥ 1.7 mmol/L or specific treatment for this lipid
abnormality
Reduced HDL cholesterol:
 Males < 1.03 mmol/L; females, < 1.29 mmol/L
 Or, specific treatment for this lipid abnormality
Hypertension:
 Systolic BP ≥ 130, or diastolic BP ≥ 85 mm Hg
 Treatment of previously diagnosed hypertension
Age-Specific Prevalence of the
Metabolic Syndrome
Ford ES. Prevalence of the metabolic syndrome among
US adults. JAMA (2002) 287(3):356-9
Nutrition & Metabolic Syndrome
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Western dietary pattern, meat
and fried foods associated
with metabolic syndrome
Lutsey et al Circulation (2008) 117 (6),
pp 754-761.
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Eating patterns consistent
with 2005 Dietary Guidelines
for Americans associated
with ↓ metabolic syndrome
prevalence
Fogli-Cawley et al AJCN (2007) 86, pp
1193-1201.
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Confusion over definition
of metabolic syndrome
criteria
Metabolic syndrome
diagnosis “Rarer than a blue
moon”
Ford ES Diabetes Care (2005) 28(7), pp.
1808-1809.
Problems/Research Questions
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The prevalence of metabolic syndrome
within the community hospital is unknown
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If metabolic syndrome does exist the
dietitian is not receiving referrals
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Therefore, metabolic syndrome inpatients
not receiving nutrition intervention
Problems/Research Questions
1.
Is there a new multidisciplinary
approach for a dietitian to
identify Metabolic Syndrome?
2.
Have Metabolic Syndrome
patients ever seen a dietitian?
Methods
Cross-sectional prospective study
 22-bed acute care community hospital
 Three month collection period
 Informed verbal consent obtained
 Anonymity of patient maintained
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1.
List of medications for metabolic syndrome
2.
3.
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Created data collection tool
Screened pharmacy profiles – Pharmacist
Reviewed charts for data
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Visited patients with Nursing
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Waist circumference
Interview
Waist Circumference
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Adapted from the Metabolic Syndrome Institute
website http://metabolicsyndromeinstitute.org
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Obtained verbal
consent
Physically located
markers
Measurement read on
exhalation
Two readings
6.
Identified those with metabolic syndrome
Results
100 patient pharmacy
profiles reviewed
46 patients EXCLUDED
from study
N = 54
patients on ≥ 1
MEDICATIONS for
metabolic syndrome
YES
n = 26 (48.1%) had
metabolic syndrome
NO
n = 28 (51.9%) did not
have metabolic syndrome
Characteristics
Metabolic Syndrome Group
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Prevalence:
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By gender:
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Men – 38.5%
Women – 61.5%
Average age:
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48%
42% - Ford et al JAMA (2002) 287, 356-359
47% - Curtis et al Diabetes Care (2007) 30, 2553-58
73 +/- 9.0 (mean +/- SD)
Metabolic syndrome not diagnosed
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Top 5: CHF, Sepsis, MI, NSTEMI, SBO
Number of Medications for Metabolic Syndrome in
Patients with and without Metabolic Syndrome
50
46
45
40
39
% of Patients
35
30
28
No MetS
MetS
25
20
18
15
15
15
12
10
8
7
4
5
4
4
0
0
0
1
2
3
4
5
6
Number of Medications Used for Metabolic Syndrome
7
R=+0.477, p<0.05
Number of Years Patients with Metabolic
Syndrome Last Consulted with a Dieitian
35.0%
34.6%
34.6%
>5 years
≤5 years
% of Patients
34.0%
33.0%
32.0%
31.0%
30.8%
30.0%
29.0%
28.0%
Never
Time Frame
Reasons Why Patients with Metabolic Syndrome
Consulted with a Dietitian
45%
38%
40%
% of Patients
35%
31%
30%
25%
20%
15%
12%
12%
10%
5%
4%
4%
Weight
Management &
Heart Healthy Diet
Diabetes &
Weight
Management
0%
Has not seen RD
Diabetes Diet
Weight
Management
General Nutrition
Reasons
Implications
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Metabolic syndrome medications:
Identification of metabolic syndrome
 Identification of central obesity
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Multidisciplinary approach to dietitian referral
Pharmacy
 Nursing
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Expedites referral to dietitian
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Patient receives nutrition intervention for metabolic
syndrome sooner
Challenges
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Time limitations
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Small sample size
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Missing data
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Data collection  Time consuming
Future Research
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Further study needed in larger institutions (e.g.
long-term care, urban hospitals, community
health centres)
Similar results in younger age groups?
Determine if nutrition intervention would
benefit metabolic syndrome patients
Conclusions
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Metabolic syndrome was
prevalent
Pharmacist can be included in
healthcare team to refer patients
with metabolic syndrome to
dietitian
There is a gap in the dietary
management of metabolic
syndrome in inpatients with
metabolic syndrome
Acknowledgements
Deborah Quintal RD CDE
Alan Gervais, Pharmacist
Adam Telner MD
Joseph Murphy RD
Louise Gariepy PhD Candidate
Shelley Graham RD CDE