Knowledge regarding Metabolic Syndrome and adherence to NCEP-ATP III clinical practice guidelines among physicians in New Providence, The Bahamas

Abstract
Background: Metabolic Syndrome is becoming an increasingly common public health problem worldwide, including in The Bahamas.
Objective: The aim of this study is to determine the knowledge of physicians in New Providence, Bahamas regarding metabolic syndrome and the adherence to NCEP-ATP III guidelines.
Methods: 110 Physicians from a wide array of specialties involved in primary care throughout the public and private sectors of New Providence, Bahamas were surveyed with a cross-sectional design using convenience sampling. Data was collected using a combined questionnaire inclusive of demographics, clinical cases, and a Modified Metabolic Syndrome Knowledge Level Scale (MetS-KS). IBM SPSS software was used to obtain descriptive and inferential statistics.
Results: 99.1% participants were familiar with the term Metabolic Syndrome, 88.1% (96) treat patients with MetS, 67% of physicians identified both the correct numbers of criteria for diagnosis and comprising the NCEP-ATP III definition of metabolic syndrome. Participants had a median score of 84.0% on Metabolic Syndrome Knowledge Level scale (MetS-KS). 53.3% of physicians use the NCEP-ATP III diagnostic criteria, 56% of participants were able to successfully identify the parameters consistent with NCEP-ATP III, and 35% of participants “often” screen patients adhering to the NCEP-ATP III guidelines.
Conclusion: There is a high level of Metabolic Syndrome Knowledge among physicians in New Providence, Bahamas. Physician participants admit to ‘sometimes’ adhering to NCEP-ATP III guidelines when screening patients for MetS. Family Medicine specialty was found to have the most knowledge of and most often uses NCEP-ATP III clinical practice guidelines for MetS. As years in practice and level of training increases, knowledge level, frequency of screening, and health education increases to ‘everytime’.

Keywords
metabolic syndrome; cardiovascular risk; knowledge; physician adherence, clinical practice guidelines

Cite this paper
DANIELLE STRACHAN-BOWLEG, Knowledge regarding Metabolic Syndrome and adherence to NCEP-ATP III clinical practice guidelines among physicians in New Providence, The Bahamas , SCIREA Journal of Clinical Medicine. Volume 6, Issue 6, December 2021 | PP. 515-624. 10.54647/cm32619

References

[ 1 ]	Ramic, E., Prasko, S., Mujanovic, O., & Gavran, L. (2016). Metabolic Syndrome - Theory and Practice. Materia Socio Medica, 28(1), 71. doi:10.5455/msm.2016.28.71-73,
[ 2 ]	Ford, E. S. (2005). Risks for All-Cause Mortality, Cardiovascular Disease, and Diabetes Associated With the Metabolic Syndrome: A summary of the evidence. Diabetes Care, 28(7), 1769-1778. doi:10.2337/diacare.28.7.1769,
[ 3 ]	Galassi, A., Reynolds, K., & He, J. (2006). Metabolic Syndrome and Risk of Cardiovascular Disease: A Meta-Analysis. The American Journal of Medicine, 119(10), 812-819. doi:10.1016/j.amjmed.2006.02.031,
[ 4 ]	Sattar, N., Gaw, A., Scherbakova, O., Ford, I., O’Reilly, D. S., Haffner, S. M., Shepherd, J. (2003). Metabolic Syndrome With and Without C-Reactive Protein as a Predictor of Coronary Heart Disease and Diabetes in the West of Scotland Coronary Prevention Study. Circulation, 108(4), 414-419. doi:10.1161/01.cir.0000080897.52664.94,
[ 5 ]	Isomaa, B., Almgren, P., Tuomi, T., Forsen, B., Lahti, K., Nissen, M., Groop, L. (2001). Cardiovascular Morbidity and Mortality Associated With the Metabolic Syndrome. Diabetes Care, 24(4), 683-689. doi:10.2337/diacare.24.4.683,
[ 6 ]	Wille, E., Scholze, J., Alegria, E., Ferri, C., Langham, S., Stevens, W., Uhl-Hochgraeber, K. (2010). Modelling the costs of care of hypertension in patients with metabolic syndrome and its consequences, in Germany, Spain and Italy. The European Journal of Health Economics, 12(3), 205-218. doi:10.1007/s10198-010-0223-9 ,
[ 7 ]	Schwarz, P., Reimann, M., Li, J., Bergmann, A., Licinio, J., Wong, M., & Bornstein, S. (2007). The Metabolic Syndrome - A Global Challenge for Prevention. Hormone and Metabolic Research, 39(11), 777-780. doi:10.1055/s-2007-990312,
[ 8 ]	Vashitz, G., Meyer, J., Parmet, Y., Henkin, Y., Peleg, R., & Gilutz, H. (2011). Physician adherence to the dyslipidemia guidelines is as challenging an issue as patient adherence. Family Practice, 28(5), 524-531. doi:10.1093/fampra/cmr025 ,
[ 9 ]	Gade, W., Schmit, J., Collins, M., & Gade, J. (2010). Beyond Obesity: The Diagnosis and Pathophysiology of Metabolic Syndrome. American Society for Clinical Laboratory Science, 23(1), 51-61. doi:10.29074/ascls.23.1.51,
[ 10 ]	Mccracken, E., Monaghan, M., & Sreenivasan, S. (2018). Pathophysiology of the metabolic syndrome. Clinics in Dermatology, 36(1), 14-20. doi:10.1016/j.clindermatol.2017.09.004,
[ 11 ]	Grundy, S., Cleeman, J., Donato, K., Eckel, R., Franklin, B. (2005). Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112, 2735-52.,
[ 12 ]	Harikrishnan, S., Sarma, S., Sanjay, G., Jeemon, P., Krishnan, M. N., Venugopal, K., Zachariah, G. (2018). Prevalence of metabolic syndrome and its risk factors in Kerala, South India: Analysis of a community based cross-sectional study. Plos One, 13(3). doi:10.1371/journal.pone.0192372 ,
[ 13 ]	Wang, M. (2005). Nutrition & Metabolism, 2(1), 3. doi:10.1186/1743-7075-2-3,
[ 14 ]	Alberti, K., & Zimmet, P. (1998). Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation. Diabetic Medicine, 15(7), 539-553. doi:10.1002/(sici)1096-9136(199807)15:73.0.co;2-s,
[ 15 ]	Alexander, C. M., Landsman, P. B., Teutsch, S. M., & Haffner, S. M. (2003). NCEP-Defined Metabolic Syndrome, Diabetes, and Prevalence of Coronary Heart Disease Among NHANES III Participants Age 50 Years and Older. Diabetes, 52(5), 1210-1214. doi:10.2337/diabetes.52.5.1210,
[ 16 ]	Ninomiya, J. K., L’Italien, G., Criqui, M. H., Whyte, J. L., Gamst, A., & Chen, R. S. (2004). Association of the Metabolic Syndrome With History of Myocardial Infarction and Stroke in the Third National Health and Nutrition Examination Survey. Circulation, 109(1), 42-46. doi:10.1161/01.cir.0000108926.04022.0c,
[ 17 ]	Comment on the provisional report from the WHO consultation. (1999). Diabetic Medicine, 16(5), 442-443. doi:10.1046/j.1464-5491.1999.00059.x,
[ 18 ]	Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. (2002). Circulation, 106(25), 3143-3143. doi:10.1161/circ.106.25.3143,
[ 19 ]	Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—the Evidence Report. National Institutes of Health. (1998) Obes Res, 6(2), 51S–209S,
[ 20 ]	Face, D. E. (2003). American College of Endocrinology Position Statement on the Insulin Resistance Syndrome*. Endocrine Practice, 9(Supplement 2), 5-21. doi:10.4158/ep.9.s2.5,
[ 21 ]	International Diabetic Federation (2006). The Metabolic Syndrome -The IDF consensus worldwide definition of the metabolic syndrome. Retrieved from https://www.idf.org/e-library/consensus-statements/60-idfconsensus-worldwide-definitionof-the-metabolic-syndrome,
[ 22 ]	You, T., Yang, R., Lyles, M. F., Gong, D., & Nicklas, B. J. (2005). Abdominal adipose tissue cytokine gene expression: Relationship to obesity and metabolic risk factors. American Journal of Physiology-Endocrinology and Metabolism, 288(4). doi:10.1152/ajpendo.00419.2004,
[ 23 ]	Joshi, A., Mehta, S., Grover, A., Talati, K., Malhotra, B., & Perin, D. M. (2013). Knowledge, Attitude, and Practices of Individuals to Prevent and Manage Metabolic Syndrome in an Indian Setting. Diabetes Technology & Therapeutics, 15(8), 644-653. doi:10.1089/dia.2012.0309,
[ 24 ]	Alberti, G., Zimmet, P., Shaw, J., Grundy, S. (2006) The IDF Consensus Worldwide Deﬁnition of the Metabolic Syndrome. Brussels: International Diabetes Foundation.,
[ 25 ]	Expert Panel On Detection, Evaluation, And Treatment Of High Blood Cholesterol In Adults. (2001). Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA: The Journal of the American Medical Association, 285(19), 2486-2497. doi:10.1001/jama.285.19.2486,
[ 26 ]	World Health Organization. (‎1999)‎. Definition, diagnosis and classification of diabetes mellitus and its complication: report of a WHO consultation. Part 1, Diagnosis and classification of diabetes mellitus. Geneva: World Health Organization, 31-33. Retrieved from http://www.who.int/iris/handle/10665/66040 ,
[ 27 ]	Zimmerman M., Mehr S. (2013) The Controversial Question of Metabolic Syndrome Can Targeting This Symptom Complex Reduce the Burden of Diabetes and Cardiovascular Disease? AJMC 19, SP2 ,
[ 28 ]	van Herpt, T. T., Dehghan, A., van Hoek, M., Ikram, M. A., Hofman, A., Sijbrands, E. J., & Franco, O. H. (2016). The clinical value of metabolic syndrome and risks of cardiometabolic events and mortality in the elderly: the Rotterdam study. Cardiovascular diabetology, 15, 69. https://doi.org/10.1186/s12933-016-0387-4,
[ 29 ]	Unwin N. (2006) The metabolic syndrome. J R Soc Med. 99(9):457-462. doi:10.1258/jrsm.99.9.457,
[ 30 ]	Scuteri A., Najjar S., Morrell C.H., Lakatta E.G. (2005) The metabolic syndrome in older individuals: prevalence and prediction of cardiovascular events: the cardiovascular health study. Diabetes Care 28, 882 -7 ,
[ 31 ]	Kahn R., Buse J., Ferrannini E., Stern M. (2005) The metabolic syndrome: time for a critical appraisal. Joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 28, 2289-304.,
[ 32 ]	Stern M.P., Williams K., Gonzalez-Villalpando C., Hunt K.J., Haffner S.M. (2004) Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and/or cardiovascular disease? Diabetes Care 27, 2676-81. ,
[ 33 ]	De Backer G., Ambrosioni E., Borch-Johnsen K. (2003) European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 24, 1601 -10,
[ 34 ]	Wassink A. M. J., Olijhoeck J. K., Visseren F. L. J. (2007) The metabolic syndrome: metabolic changes with vascular consequences. European Journal of Clinical Investigation, 37, 8-17.,
[ 35 ]	Vinicor, F., & Bowman, B. (2004). The Metabolic Syndrome: The Emperor Needs Some Consistent Clothes: Response to Davidson and Alexander. Diabetes Care, 27(5), 1243-1243. doi:10.2337/diacare.27.5.1243,
[ 36 ]	Mph, E. S. (2003). Insulin Resistance Syndrome: The Public Health Challenge. Endocrine Practice, 9 (Supplement 2), 23-25. doi:10.4158/ep.9.s2.23,
[ 37 ]	Lakka, H. (2002). The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-aged Men. Jama, 288(21), 2709. doi:10.1001/jama.288.21.2709 ,
[ 38 ]	Hunt, K. J., Resendez, R. G., Williams, K., Haffner, S. M., & Stern, M. P. (2004). National Cholesterol Education Program Versus World Health Organization Metabolic Syndrome in Relation to All-Cause and Cardiovascular Mortality in the San Antonio Heart Study. Circulation, 110(10), 1251-1257. doi:10.1161/01.cir.0000140762.04598.f9,
[ 39 ]	Assmann, G., Guerra, R., Fox, G., Cullen, P., Schulte, H., Willett, D., & Grundy, S. M. (2007). Harmonizing the Definition of the Metabolic Syndrome: Comparison of the Criteria of the Adult Treatment Panel III and the International Diabetes Federation in United States American and European Populations. The American Journal of Cardiology, 99(4), 541-548. doi:10.1016/j.amjcard.2006.08.045,
[ 40 ]	Grundy S., Cleeman J., Bairey Merz C.N., Brewer H.B., Clark L. T., Hunninghake D., Pasternak R., Smith S., Stone N. J. (2004) Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol. 44, 720-32.,
[ 41 ]	Health Information & Research Unit. (2005). Healthy lifestyle in The Bahamas: Findings from the Bahamas CNCD Prevalence study and risk factor survey (February – March, 2005). Retrieved from https://www.bahamas.gov.bs/wps/wcm/connect/ddbe77af-6349-4f4988d1-a3ca4897c2ad/Healthy+Lifestyles+Summary.pdf?MOD=AJPERES,
[ 42 ]	Bahamas Government. (June 2011 to March 2012). Bahamas (Site) STEPS Survey 2012 [Fact Sheet]. Retrieved from https://www.bahamas.gov.bs/wps/wcm/connect/e6091699-8e84-4304-a1b5-813fde735f6e/FactSheet_-2013+BAH+-+060314+Update+Final.pdf?MOD=AJPERES,
[ 43 ]	Brennen, D., Brathwaite, N.,& Deleveaux,C.(2014). The Prevalence of raised blood pressure and self-reported hypertension in The Bahamas: Findings from the STEPS Survey, 2012. Presented at UWI Research day 2014. Nassau, Bahamas. Retrieved from https://www.bahamas.gov.bs/wps/wcm/connect/40048036-76ef-4e42-921865670b9e7eb7/UWI+Hypertension+Presentation+%282014%29.pdf?MOD=AJPERES,
[ 44 ]	Ferguson, T., Younger, N., Tulloch-Reid, M., Forrester, T., Cooper, R., VandenBroeck, J., Wilks, R. (2010). Prevalence of the Metabolic Syndrome in Jamaican Adults and its Relationship to Income and Education Levels. West Indian Med J 59(3), 265,
[ 45 ]	Ezenwaka, C., Nwagbara, E., Seales, D., Okali, F., Hussaini, S., Raja, B., Wheeler, V., Sell, H., Avci, H., & Eckel, J. (2007). A comparative study of the prevalence of the metabolic syndrome and its components in type 2 diabetic patients in two Caribbean islands using the new International Diabetes Federation deﬁnition. Archives of Physiology and Biochemistry 113(4/5), 202–210,
[ 46 ]	Cherry, C. O., Serieux, E., Didier, M., Nuttal, M. E., & Schuster, R. J. (2014). Prevalence of Risk Factors for the Metabolic Syndrome in the Middle Income Caribbean Nation of St. Lucia. Advances in Preventive Medicine, 2014, 1-5. doi:10.1155/2014/501972 ,
[ 47 ]	Saklayen, M. G. (2018). The Global Epidemic of the Metabolic Syndrome. Current Hypertension Reports, 20(2). doi:10.1007/s11906-018-0812-z ,
[ 48 ]	Falkner, B., & Cossrow, N. D. (2014). Prevalence of Metabolic Syndrome and Obesity-Associated Hypertension in the Racial Ethnic Minorities of the United States. Current Hypertension Reports, 16(7). doi:10.1007/s11906-014-0449-5,
[ 49 ]	Shin, D., Kongpakpaisarn, K., & Bohra, C. (2018). Trends in the prevalence of metabolic syndrome and its components in the United States 2007–2014. International Journal of Cardiology, 259, 216-219. doi:10.1016/j.ijcard.2018.01.139,
[ 50 ]	Helminen, E., Mäntyselkä, P., Nykänen, I., & Kumpusalo, E. (2009). Far from easy and accurate - detection of metabolic syndrome by general practitioners. BMC Family Practice, 10(1). doi:10.1186/1471-2296-10-76,
[ 51 ]	Ullah. (2011). The Awareness and Prevalence of Metabolic Syndrome in Medical Community of Bahawalpur. Oman Medical Journal, 26(1), 26-28. doi:10.5001/omj.2011.07 ,
[ 52 ]	Smith, S. C., & Haslam, D. (2006). Abdominal obesity, waist circumference and cardiometabolic risk: Awareness among primary care physicians, the general population and patients at risk – the Shape of the Nations survey. Current Medical Research and Opinion, 23(1), 29-47. doi:10.1185/030079906x159489 ,
[ 53 ]	Havakuk, O., Perl, M. L., Praisler, O., Barkagan, M., Sadeh, B., Margolis, G., Arbel, Y. (2017). The awareness to metabolic syndrome among hospital health providers. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 11(3), 193-197. doi:10.1016/j.dsx.2016.09.005,
[ 54 ]	Echlin, P. S., Upshur, R. E., & Markova, T. P. (2004). Lack of chart reminder effectiveness on family medicine resident JNC-VI and NCEP III guideline knowledge and attitudes. BMC Family Practice, 5(1). doi:10.1186/1471-2296-5-14 ,
[ 55 ]	Al-Gelban, S. K., Yunus Khan, M., Al-Khaldi, Y. M. (2011). Adherence of Primary Health Care Physicians to Hypertension Management Guidelines in the Aseer Region of Saudi Arabia, Saudi J Kidney Dis Transpl 22(5), 941-948. pmid: 21912023,
[ 56 ]	Atalay, B. (2018). Development of Metabolic Syndrome Knowledge Level Scale (MetS-KS) and its validity and reliability study for Turkey. Indian Journal of Research, 7(1). ISSN 2250-1991 ,
[ 57 ]	Bahamas Government. (January 2019 to April 2019). Bahamas (Site) STEPS Survey 2019 [Fact Sheet]. Retrieved from http://www.bahamas.gov.bs/wps/wcm/connect/891fac39-ad7d4aa8ac5439912a1afcea/Preliminary+Factsheet+v7+%28med+resl%27n%29.pdf?MOD=AJPERES,
[ 58 ]	Giuseppe M., Ilenia C., Emilio N., Giovanni C., Santina C. (2014). Metabolic syndrome in hypertensive patients: An unholy alliance. World J Cardiology, 6(9), 890–907.,
[ 59 ]	Mancia G., Bombelli M., Corrao G., Facchetti R., Madotto F., Giannattasio C., Trevano F.Q., Grassi G., Zanchetti A., Sega R. (2007). Metabolic syndrome in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study: daily life blood pressure, cardiac damage, and prognosis. Hypertension 49, 40–47.,
[ 60 ]	Schillaci G., Pirro M., Vaudo G., Gemelli F., Marchesi S., Porcellati C., Mannarino E. (2004). Prognostic value of the metabolic syndrome in essential hypertension. J Am Coll Cardiol. 43, 1817–1822.,
[ 61 ]	Cabrera-Pivaral C. E., Gutiérrez-Ruvalcaba C. L., Peralta-Heredia I. C. (2008). Development and validation of an instrument to measure family physicians’ clinical aptitude in metabolic syndrome in Mexico. Salud Publica Mex. 50(6), 457-462.,
[ 62 ]	Hoyas, I., Leon-Sanz, M. (2019). Nutritional Challenges in Metabolic Syndrome. J Clin Med. 8(9), 1301. doi:10.3390/jcm8091301,
[ 63 ]	McMillan-Price J., Petocz P., Atkinson F., O’Neill K., Samman S., Caterson I., Brand-Miller J. (2006). Comparison of 4 diets of varying glycemic load on weight loss and cardiovascular risk reduction in overweight and obese young adults: A randomized controlled trial. Arch. Intern. Med. 166:1466–1475. doi:10.1001/archinte.166.14.1466. ,
[ 64 ]	Horton E.S. (2009) Effects of lifestyle changes to reduce risks of diabetes and associated cardiovascular risks: Results from large-scale efficacy trials. Obesity.17:S43–S48. doi:10.1038/oby.2009.388 ,
[ 65 ]	Buyken A.E., Toeller M., Heitkamp G., Karamanos B., Rottiers R., Muggeo M. (2001). The Eurodiab Iddm Complications Study Group Glycemic index in the diet of European outpatients with type 1 diabetes: Relations to glycated hemoglobin and serum lipids. Am. J. Clin. Nutr. 73, 574–581. doi:10.1093/ajcn/73.3.574 ,
[ 66 ]	Brand-Miller J., Hayne S., Petocz P., Colagiuri S. (2003). Low-glycemic index diets in the management of diabetes. A meta-analysis of randomized controlled trials. Diabetes Care. 26, 2261–2267. doi:10.2337/diacare.26.8.2261,
[ 67 ]	Case C.C., Jones P.H., Nelson K., Smith E.O., Ballantyne C.M. (2002). Impact of weight loss on the metabolic syndrome. Diabetes Obes. Metab. 4, 407–414. doi:10.1046/j.1463-1326.2002.00236.x ,
[ 68 ]	Phelan S., A Wadden T., I Berkowitz R., Sarwer D.B., Womble L.G., Cato R.K., Rothman R. (2007). Impact of weight loss on the metabolic syndrome. Int. J. Obes. 31, 1442–1448. doi:10.1038/sj.ijo.0803606 ,
[ 69 ]	Nestel P. (2004). Nutritional aspects in the causation and management of the metabolic syndrome. Endocrinol. Metab. Clin. N. Am. 33, 483–492. doi:10.1016/j.ecl.2004.03.010 ,
[ 70 ]	Ninomiya J.K., L’Italien G., Criqui M., Whyte J.L., Gamst A., Chen R. S. (2004). Association of the Metabolic Syndrome With History of Myocardial Infarction and Stroke in the Third National Health and Nutrition Examination Survey. Circulation. 109, 42–46. doi.org/10.1161/01.CIR.0000108926.04022.0C,
[ 71 ]	Ranjani H., Mohan V. (2009) Prevention and Control of Noncommunicable Diseases Role of Family Physicians in Improving Compliance to Lifestyle Modification. The Asian Journal of Diabetology. Vol. 11, no. 2,
[ 72 ]	Bain D., Patterson K., Deveaux G., Bevans S., Albury J., Frankson M., Pinder-Butler S., Hanna-Mahase C. (2015) Pharmacologic Adherence to the Joint National Committee VII Guidelines amongst Family Physicians at the Family Medicine Clinic Nassau, Bahamas. Public Hospital Authority Family Medicine Clinic, Department of Family Medicine, University of the West Indies, Nassau Campus, Bahamas.,