Cardiometabolic Think Tank Maps Next Steps For Metabolic Syndrome Patient Care

An innovative patient care model for metabolic syndrome must accurately identify patients at risk before metabolic syndrome develops and must recognize subtypes and stages of metabolic syndrome to more effectively direct prevention and therapies, according to a state-of-the-art review published Aug. 24 in the Journal of the American College of Cardiology (JACC).

The review includes findings from a Cardiometabolic Think Tank convened in June 2014, to explore issues surrounding cardiometabolic risk and disease and metabolic syndrome. The think tank, composed of the Cardiometabolic Health Alliance among others, organized its proceedings around three core topics: deconstructing metabolic syndrome into its components; constructing a new care model through an interdisciplinary approach; and implementing the new care model in the real world. Deconstructing metabolic syndrome into smaller targets (insulin resistance, residual risk, lifestyle, obesity, disparities, etc.), laid the groundwork for the discussion of an effective interdisciplinary care model.

Several essential focus points for the care model were identified, including comprehensive screening/case-finding strategies; considering varying types of metabolic syndrome phenotypes; formulating a staging system to facilitate communication between patients and providers; and building a paradigm of care involving individual, community and public health that emphasizes lifestyle choices. The proposed model first categorizes patients based on the progression of their disease, and secondly by underlying metabolic syndrome pathophysiology.

According to the review authors, with the challenge of implementation, bridging communities should be a primary focus. Stakeholders from the public health arena, industry and the health care system must be involved, in addition to patient advocates, community health workers and peer leaders all play an integral role. Overall, the principles for implementing this care model include care coordination and team-based care; education in metabolic syndrome recognition and treatment; technology to facilitate communication among providers and patients; disease registries for population management; social media for distributing health messages; reimbursement alignment to facilitate coordinated care; and further development of strategies to address health care disparities and barriers to care.

Moving forward, more data must be collected in order to develop an expert consensus on the diagnostic subtyping and staging of metabolic syndrome to improve personalized patient care. According to the authors, future think tank initiatives will supply data on the combined use of pharmaceuticals, structured lifestyle, behavioral interventions, and surgical/nonsurgical bariatric procedures to improve morbidity and mortality among patients at risk for metabolic syndrome. In addition to an increase in data collection, there must also be greater focus on prevention, including the assessment of nutritional quality and physical activity.

As health care broadens to include population health, community and industry sectors, future efforts will also include encouraging partnerships, funding and other initiatives to further improve the lives of people suffering from metabolic syndrome.

Listen to the audio commentary by JACC Editor-in-Chief Valentin Fuster, MD, PhD, MACC.

Clinical Topics: Diabetes and Cardiometabolic Disease

Keywords: Bariatric Surgery, Healthcare Disparities, Insulin Resistance, Life Style, Insurance Pools, Metabolic Syndrome X, Motor Activity, Nutritive Value, Obesity, Patient Care, Phenotype, Public Health

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