Sensitivity of Current Methods for Diagnosing and Documenting Metabolic Syndrome Within a Large Community-Based Health Care System

Background: Metabolic syndrome (MetS) is a constellation of metabolic conditions, including abdominal obesity, high blood pressure, high triglyceride level, low high-density-lipoprotein level and high fasting blood glucose level, that increase the risk of developing chronic health conditions. Various combinations of diagnostic criteria have been proposed, including those by the National Cholesterol Education Program Adult Treatment Panel III (ATP III), World Health Organization (WHO) and International Diabetes Foundation (IDF), among others. However, inconsistent use of diagnostic criteria and inadequate scientific evidence supporting use of specific criteria are current problems in health care. Purpose: Quantify the prevalence of MetS diagnosis within the Aurora Health Care patient population and determine the sensitivity (ie, accuracy) achieved in documenting MetS within Aurora, recognizing ATP III, WHO and IDF definitions of MetS as diagnostic gold standards. Methods: We conducted a retrospective review of all patients encountered within Aurora from January 1, 2012, to December 31, 2015. Patients were examined to determine the occurrence and associated dates of MetS diagnosis and all indications of satisfied MetS diagnostic criteria. Indications of obesity, hyperglycemia, hypertriglyceridemia, hypoalphalipoproteinemia and hypertension, as variably defined in ATP III, WHO and IDF guidelines, included relevant diagnoses, abnormal clinical and laboratory test results and use of medications. Sociodemographic data also were collected. Results: In total, 1,369,620 unique patients visited Aurora during the study period, with 28% of patients aged ≥ 60 years and most identifying as non-Hispanic white (76.8%) or black (9.93%) race. Only 4,978 patients (0.36%) received a clinical diagnosis of MetS despite evidence of satisfied ATP III and WHO criteria in 12.0% and 16.7% of patients, respectively. Satisfaction of IDF criteria occurred in only 0.16% of patients. Except for hyperglycemia, individual diagnostic criteria also showed lower-than-expected rates of clinical diagnosis. For example, obesity was diagnosed in 7.86% of patients but suggested in 39.3% of patients with body mass index ≥ 30 kg/m2. The true positive rate (ie, percentage of patients with satisfied criteria who also were clinically diagnosed) was lowest in older, male, black or Hispanic patients. Conclusion: Within Aurora, metabolic syndrome is rarely and variably diagnosed in medical practice, despite clear evidence of satisfied ATP III and WHO criteria