When should I consider referring a patient with metabolic syndrome to a specialist?

Consider referring a patient with metabolic syndrome to a specialist when they have significant comorbidities or complex needs related to overweight or obesity, such as type 2 diabetes, hypertension, dyslipidaemia, or other cardiovascular risk factors that are difficult to manage in primary care.

Specifically, referral is appropriate if the patient has:

• Severe obesity with associated comorbidities requiring specialist assessment and management ¹.
• Markedly abnormal lipid profiles suggestive of familial lipid disorders or triglyceride levels above 10 mmol/L after excluding secondary causes, warranting specialist lipid assessment ².
• Complications such as poorly controlled blood glucose or hypertension despite initial management, or other metabolic complications that need specialist input ¹,².
• Complex needs including physical disabilities, learning disabilities, or other special educational needs and disabilities (SEND) that complicate management ¹.

Referral should also be considered when lifestyle and behavioural interventions in primary care have been insufficient, and higher-level interventions or multidisciplinary input are needed ¹.