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Nutrition and exercise modification in patients Nutrition and exercise modification in patients with Metabolic Syndrome:with Metabolic Syndrome:

Results of the DETECT Study in 55.000 Primary Care Results of the DETECT Study in 55.000 Primary Care

patientspatients

Hans-Ulrich Wittchen und die DETECT Study Group,

Technical University Dresden

Institute of Clinical Psychology and Psychotherapy

AG Epidemiologie und Gesundheitsberichterstattung

Lars Pieper, Jens Klotsche, Hans-Ulrich Wittchen

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Definition of the Metabolic Syndrome according to the criteria of the International Diabetes Federation (IDF, 2005)

2nd International Symposium on 2nd International Symposium on „The Metabolic Syndrome – a postprandial disease” „The Metabolic Syndrome – a postprandial disease”

Central obesity (defined as waist circumference > 94cm for Europid men and > 80cm for Europid women, with ethnicity specific values for other groups) plus any two of the following four factors:

• raised TG level: > 150 mg/dL, or specific treatment for thislipid abnormality

• reduced HDL cholesterol: < 40 mg/dL in males and < 50mg/dL in females, or specific treatment for this lipid abnormality

• raised blood pressure: systolic BP > 130 or diastolic BP > 85 mm Hg, or treatment of previously diagnosed hypertension

• raised fasting plasma glucose (FPG) > 100 mg/dL, or previously diagnosed type 2 diabetes

Change of lifestyle factors like behavioural modification of nutrition and exercise represents the main intervention in patients with Metabolic Syndrome with and without concomitant drug therapy.

Background

Aims

(1) To determine the prevalence of the metabolic syndrome in primary care

(2) To describe the frequency of interventions to modify nutrition- and exercise-behaviour in primary care patients with or without concomitant drug therapy.

2nd International Symposium on 2nd International Symposium on „The Metabolic Syndrome – a postprandial disease” „The Metabolic Syndrome – a postprandial disease”

509 (16%)

273 (8.6%)

217 (6,8%)

54 (1,7%)

161 (5.1%)

639 (20%)

302 (9.5%)

64 (2%)

24 (0.8%)

24 (0.8%)

143 (4.5%)

257 (8.1%)

137 (4.3%)

121 (3.8%)

110 (3.5%)

153 (4.8%)

DETECT Study: Physician sample (n=3,188)

General practitioner(N=2.323)Bayern 381 (16.4%)Baden-Württemberg 202 (8.7%)Hessen 162 (7.0%)Saarland 38 (1.6%)Rheinland-Pfalz 115 (5.0%)NRW 434 (18.7%)Niedersachsen 232 (10%)Schleswig-Holstein 43 (1.9%)Bremen 12 (0.5%)Hamburg 16 (0.7%)Berlin 78 (3.4%)Sachsen 205 (8.8%)Sachsen-Anhalt 114 (4.9%)Meck-Vorpommern 97 (4.3%)Thüringen 91 (3.9%)Brandenburg 103 (4.4%)

Internist (N=865)Bayern 128 (14.8%)Baden-Württemberg 71 (8.2%)Hessen 55 (6.4%)Saarland 16 (1.9%)Rheinland-Pfalz 46 (5.3%)NRW 205 (23.7%)Niedersachsen 70 (8.1%)Schleswig-Holstein 21 (2.4%)Bremen 12 (1.4%)Hamburg 8 (0.9%)Berlin 65 (7.5%)Sachsen 52 (6.0%)Sachsen-Anhalt 23 (2.7%)Meck-Vorpommern 24 (2.8%)Thüringen 19 (2.2%)Brandenburg 50 (5.8%)

Prestudy (3.795 physicians)

Main Study (55.518 patients)

outcomemonitoring

12-Month-Follow-up (laboratory subsample 7.500 patients)

outcomemonitoring

5-Year Follow-up

2003

2004

2007

DETECT Design

Physician questionnairePatient questionnaire Laboratory values

2nd International Symposium on 2nd International Symposium on „The Metabolic Syndrome – a postprandial disease” „The Metabolic Syndrome – a postprandial disease”

Results – Prevalence of the Metabolic Syndrome

54,9

65,568,768,7

63,158,9

51,1

40,4

33,3

25,3

19,016,3

11,3

0

10

20

30

40

50

60

70

80

Total 18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

age groups

%

Male

Female

Total

2nd International Symposium on 2nd International Symposium on „The Metabolic Syndrome – a postprandial disease” „The Metabolic Syndrome – a postprandial disease”

2nd International Symposium on 2nd International Symposium on „The Metabolic Syndrome – a postprandial disease” „The Metabolic Syndrome – a postprandial disease”

4,4 6,1 6,912,6

18,4

28,2

38,947,2

54,961,4 63,4

8,9

6,910,2 12,1

12,8

14,9

12,2

12,2

11,7

8,2

7,2 5,34,5

61,0

46,0

0

10

20

30

40

50

60

70

80

Total 18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

age groups

%

no drug therapy

any drug therapy

Results – Prevalence of the Metabolic Syndrome

20,3

12,3

0 10 20 30 40 50 60 70Percent

Patient rated long-term helpfulness

16,1

11,3

56,3

52,6

27,7

36,1

0% 20% 40% 60% 80% 100%

Nutrition

Exercise/sport

not helpful some helpful very helpful

PatientPhysician

54,8

19,9

0 10 20 30 40 50 60 70

Nutritionconsulting/education

Exercise andsport

Percent

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Results – Nutrition and exercise modification

realisation, referral participation

13,1

14,3

21,6

12,1

0 10 20 30 40 50 60 70Percent

any drug therapy

no drug therapy37,6

16,9

58,3

20,5

0 10 20 30 40 50 60 70

Nutritionconsulting/education

Exercise andsport

Percent

any drug therapy

no drug therapy

2nd International Symposium on 2nd International Symposium on „The Metabolic Syndrome – a postprandial disease” „The Metabolic Syndrome – a postprandial disease”

Results – Nutrition and exercise modification

Patient rated long-term helpfulness

PatientPhysicianrealisation, referral participation

*

* *

n.s.

17,7

15,8

8,5

12

54,3

56,6

52,1

52,8

28

27,6

39,4

35,3

0% 20% 40% 60% 80% 100%

Nutrition

Exercise/sport

not helpful some helpful very helpful

any drug therapy

any drug therapy

no drug therapy

no drug therapy

* *

*

n.s.

n.s. n.s.

Conclusions

- DETECT reveal that more then 50% of the patients in primary care meet the IDF criteria for the metabolic syndrom

- Increasing prevalence until the age of 70; prevalence higher in men than in women

- Nearly 20% of the patients with Metabolic Syndrome receive no medication

- Advices to change nutrition behaviour were only given in slightly above 50% of the patients (regarding exercise modification in only 20% of the patients)

- There is a gap between physician and patient data on the prescription of nutrition and exercise interventions

- About 15% of the patients do not benefit from these non-medical interventions

- Patients without medication receive less interventions to modify nutrition and exercise

2nd International Symposium on 2nd International Symposium on „The Metabolic Syndrome – a postprandial disease” „The Metabolic Syndrome – a postprandial disease”

There is a great potential to improve to implementation of non-medical, behavioural interventions in primary care. But how?

- DMP’s: but only for single disease

- Case management ….

Acknowledgments/ Disclosures

DETECT-Study Group:

Prof. Dr. H.-U. Wittchen (Dresden, München; PI)Prof. Dr. H. Lehnert (Magdeburg , Warwick)Prof. Dr. G. Stalla (München)Prof. Dr. M. A. Zeiher (Frankfurt) Prof. Dr. W. März (Graz)Prof. Dr. S. Silber (München) PD Dr. D. Pittrow (Starnberg/Dresden), Prof. Dr. Dr. U. Koch (Hamburg), Dr. H. Schneider (Turin), Dr. H. Glaesmer, E. Katze, Dipl.-Math. J. Klotsche, Dipl.-Psych. L. Pieper

Wie would like to thank all the participating primary care physicians for their support and collaboration.

DETECT is supported by an unrestricted educational grant of Pfizer GmbH, Karlsruhe, Germany.

More Information at: http://www.detect-studie.de

2nd International Symposium on 2nd International Symposium on „The Metabolic Syndrome – a postprandial disease” „The Metabolic Syndrome – a postprandial disease”