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Presented by: Simon Leung, Dietetic Intern July 17, 2008

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. Metabolic Syndrome Overview Problem/Research Questions Methods

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Presented by: Simon Leung, Dietetic Intern July 17, 2008

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  1. 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

  2. Outline • Metabolic Syndrome Overview • Problem/Research Questions • Methods • Results • Challenges • Future Research • Conclusions • Acknowledgements

  3. Metabolic Syndrome Overview • A cluster of metabolic risk factors that: • ↑risk of CVD ~2-fold • ↑ risk of Type-2 diabetes development ~5-fold • Prevalence in North America: • Approximately ~25%

  4. Characteristics of the Metabolic Syndrome Abdominal obesity Glucose intolerance/ Insulin resistance Hypertension Atherogenic dyslipidemia Diabetes CVD Adapted from National Cholesterol Educational Program (NCEP), Adult Treatment Panel (ATP) III; 2001. Slide source: www.obesityonline.org

  5. International Diabetes Federation (IDF) Definition of Metabolic Syndrome 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

  6. Age-Specific Prevalence of the Metabolic Syndrome Ford ES. Prevalence of the metabolic syndrome among US adults. JAMA (2002) 287(3):356-9

  7. Nutrition & Metabolic Syndrome • Western dietary pattern, meat and fried foods associated with metabolic syndrome Lutsey et al Circulation (2008) 117 (6), pp 754-761. • Eating patterns consistent with 2005 Dietary Guidelines for Americans associated with ↓ metabolic syndrome prevalence Fogli-Cawley et al AJCN (2007) 86, pp 1193-1201.

  8. 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.

  9. Problems/Research Questions • The prevalence of metabolic syndrome within the community hospital is unknown • If metabolic syndrome does exist the dietitian is not receiving referrals • Therefore, metabolic syndrome inpatients not receiving nutrition intervention

  10. Problems/Research Questions • Is there a new multidisciplinary approach for a dietitian to identify Metabolic Syndrome? • Have Metabolic Syndrome patients ever seen a dietitian?

  11. Methods • Cross-sectional prospective study • 22-bed acute care community hospital • Three month collection period • Informed verbal consent obtained • Anonymity of patient maintained

  12. 1.List of medications for metabolic syndrome

  13. Created data collection tool • Screened pharmacy profiles – Pharmacist • Reviewed charts for data

  14. 5. Visited patients with Nursing • Waist circumference • Interview

  15. Waist Circumference • Obtained verbal consent • Physically located markers • Measurement read on exhalation • Two readings Adapted from the Metabolic Syndrome Institute website http://metabolicsyndromeinstitute.org

  16. 6. Identified those with metabolic syndrome

  17. Results 100patient pharmacy profiles reviewed 46patients EXCLUDEDfrom 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

  18. Characteristics Metabolic Syndrome Group • Prevalence: • 48% • 42% - Ford et al JAMA (2002) 287, 356-359 • 47% - Curtis et al Diabetes Care (2007) 30, 2553-58 • By gender: • Men – 38.5% • Women – 61.5% • Average age: • 73 +/- 9.0 (mean +/- SD) • Metabolic syndrome not diagnosed • Top 5: CHF, Sepsis, MI, NSTEMI, SBO

  19. R=+0.477, p<0.05

  20. Implications • Metabolic syndrome medications: • Identification of metabolic syndrome • Identification of central obesity • Multidisciplinary approach to dietitian referral • Pharmacy • Nursing • Expedites referral to dietitian • Patient receives nutrition intervention for metabolic syndrome sooner

  21. Challenges • Time limitations • Small sample size • Missing data • Data collection  Time consuming

  22. Future Research • 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

  23. Conclusions • 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

  24. Acknowledgements Deborah Quintal RD CDE Alan Gervais, Pharmacist Adam Telner MD Joseph Murphy RD Louise Gariepy PhD Candidate Shelley Graham RD CDE

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