Abstract 6266: Targeting Metabolic Syndrome: A New Approach to Intensive Lifestyle Intervention and Self Management Support
Metabolic syndrome is a constellation of increased abdominal obesity associated with dyslipidemia, impaired glucose tolerance and hypertension. Metabolic syndrome is a recognized risk factor for atherosclerosis and diabetes. The pathogenesis of metabolic syndrome is thought to be due to environmental influences on susceptible individuals. The impact of lifestyle intervention on reducing the prevalence of metabolic syndrome is unknown. We initiated the first Metabolic Syndrome Program in Canada. The program is aimed at individuals without clinical evidence of vascular disease or overt diabetes. The program is 18 months in duration and is based on an expanded chronic care model and focuses on lifestyle modification. No new pharmacotherapy is initiated in the first 12 months. The program is a nurse managed, physician supported model and features a multidisciplinary team of physicians, advanced practice nurses, dietitians, exercise physiologists, occupational therapist and clinical psychologists. The program includes both individual counselling and group visits. The central themes of the program are collaborative goal setting between subjects and team members, stress management, motivation enhancement for behaviour change, self management support and prevention of relapse. The baseline characteristics of the first 217 subjects (age 51±11y, male 32%) enrolled in the program are listed in the Table⇓. At 6 and 12 months there are significant improvements in triglycerides, anthropometrics and blood pressure (Table⇓). Importantly, 43% of subjects no longer fulfil the criteria for metabolic syndrome criteria after 12 months. We conclude that a multidisciplinary program aimed at intensive lifestyle modification can reduce the prevalence of metabolic syndrome. Longer follow up is required to determine whether the improvements can be sustained and whether these improvements can translate into reductions in cardiovascular event rates.