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Prim Care Diabetes. 2009 Feb;3(1):29-35. doi: 10.1016/j.pcd.2008.12.002. Epub 2009 Jan 19.

How are we diagnosing cardiometabolic risk in primary care settings?

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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.



To assess attitudes, barriers and practices of clinicians in assessing and treating cardiometabolic risk in overweight adults.


In 2006, primary care physicians and mid-level practitioners in Montana were surveyed (N=430).


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%).


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.

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