Process - Physician - Fraser Health Authority

Mental Health and Substance Use Revised April 11, 2011CLINICAL ALGORITHM FOR METABOLIC MONITORINGLEGENDWithin normal range: No actionFurther action requiredTreatment requiredPhysical measuresABDOMINAL OBESITYWeightWaistcircumference*WeightWaistcircumference*BLOOD PRESSURE< 5% increase in weight from baseline< 102 cm/40 in or < 88 cm/35 in> 5% increase in weight from baseline≥ 102 cm/40 in or < 88 cm/35 inscreening & assessment* See Guidelines Table 1 for ethnic-specific guidelines< 140/90 mmHg (if no co-morbid conditions)> 140/90 mmHg (> 135/85 if self-measured, > 130/80 ifdiabetes, renal disease or other target organ disease)Drug treatment for hypertension (antihypertensive)If LOW RISKIf MODERATE RISKIf HIGH RISKIf LOW RISKIf MODERATE RISKIf HIGH RISKprevention & interventionRepeat measurement and treat / referas per BC overweight and obesityguidelinesRepeat measurement and treat / referas per BC hypertension guidelinesRepeat annuallyRepeat 3-monthlyRepeat annuallyRepeat 3-monthlymonitoring• Repeat monthly for 3 months and until stable,• Then 3-monthly• Repeat monthly for 3 months and until stable,• Then 3-monthlyFASTING LIPIDSTriglycerides (TG)≤ 1.7 mmol/LIf LOW RISKRepeat annuallyLaboratory investigationsHDL-cholesterol ≥ 1.03 mmol/L or ≥ 1.29 mmol/LTriglycerides (TG) > 1.7 mmol/LHDL-cholesterol < 1,03 mmol/L or < 1.29 mmol/LDrug treatment for dyslipidemiaFASTING BLOOD GLUCOSEFasting plasma < 5.6 mmol/Lglucose (FPG) 5.6 – 6.9 mmol/L≥ 7.0 mmol/LDrug treatment for elevated glucoseIf MODERATE RISKIf HIGH RISKIf LOW RISKIf MODERATE RISKIf HIGH RISKTreat / refer as perBC cardiovascular disease guidelinesTreat / refer as perBC diabetes care guidelines• Annually• If ≥ 5% weight increase or if lipids abnormal, repeat 6-• monthly until stable, then annually• Repeat 3-monthly for 6 months and until stable,• Then annuallyRepeat annually• Annually• If ≥ 5% weight increase, repeat 6-monthly until stable,• then annually• Repeat 3-monthly for 6 months and until stable,• Then annuallyHealthy lifestyle education: At each stage/review point, clients should be referred to healthy lifestyle education and/or their participation in healthy lifestyle education should be reviewed