Harmonised Criteria (2009)
Metabolic syndrome is diagnosed when ≥ 3 of 5 criteria are met. No single criterion is mandatory.
| Criterion | Threshold |
|---|
| Waist circumference | Population- and sex-specific (see table below) |
| Triglycerides | ≥ 1.7 mmol/L (or on drug Rx) |
| HDL-C | < 1.0 mmol/L (M) or < 1.3 mmol/L (F) (or on drug Rx) |
| Blood pressure | ≥ 130 systolic or ≥ 85 diastolic (or on antihypertensive Rx) |
| Fasting glucose | ≥ 5.6 mmol/L (or on drug Rx / known T2DM) |
Waist Circumference Thresholds (IDF)
| Population | Male | Female |
|---|
| Caucasian | ≥ 94 cm* | ≥ 80 cm |
| South / East Asian | ≥ 90 cm | ≥ 80 cm |
| Aboriginal / Torres Strait Islander | ≥ 90 cm | ≥ 80 cm |
| Pacific Islander / Māori | ≥ 102 cm | ≥ 88 cm |
| Middle Eastern / Mediterranean | ≥ 94 cm | ≥ 80 cm |
| Sub-Saharan African | ≥ 94 cm | ≥ 80 cm |
| Central / South American | ≥ 90 cm | ≥ 80 cm |
* IDF recommends 94 cm for Caucasian males. AHA/NHLBI uses 102 cm for North American males. The harmonised statement allows either based on clinical judgement. This calculator uses IDF thresholds (lower, more sensitive) as recommended for Australian practice.
Management Targets
| Risk Factor | Target |
|---|
| Waist | Below population threshold. 5–10% weight loss is the initial goal. |
| Triglycerides | < 1.7 mmol/L. Lifestyle first; consider fibrate or omega-3 if persistent. |
| HDL-C | > 1.0 (M) / > 1.3 (F) mmol/L. Exercise is the most effective intervention. |
| Blood pressure | < 130/80 (or < 140/90 per NHF for low-mod risk). ACEi/ARB preferred if comorbid diabetes. |
| Fasting glucose | < 5.6 mmol/L. If 5.6–6.9 → impaired fasting glucose → lifestyle + annual HbA1c. If ≥ 7.0 → diabetes workup. |
Associated Screening
MAFLD (GESA 2024): All patients with metabolic syndrome should be screened for MAFLD — liver ultrasound + FIB-4 score. MAFLD is present in ~60–80% of patients with MetSy.
Obstructive Sleep Apnoea: High comorbidity with MetSy. Screen with STOP-Bang questionnaire. Score ≥ 3 → refer for sleep study.
Aus CVD Risk: Calculate absolute 5-year cardiovascular risk (Aus CVD Risk Calculator). MetSy amplifies risk — a "moderate" risk patient may warrant treatment escalation.
HbA1c: If fasting glucose 5.6–6.9 mmol/L, check HbA1c. If 42–47 mmol/mol → prediabetes → lifestyle program + annual monitoring.
RACGP Billing & Care Planning
Item 965 — GP Chronic Condition Management Plan (GPCCMP):
Replaces the old GPMP (721) and TCA (723) from 1 July 2025. A single streamlined item — no separate TCA needed. MetSy present or likely present > 6 months qualifies. Can be prepared once every 12 months (if necessary). Rebate: $156.55. Claiming Item 965 ensures eligibility for Medicare-subsidised allied health services — up to 5 allied health visits per calendar year. High-yield referrals: Accredited Practising Dietitian, Exercise Physiologist.
Item 967 — GPCCMP Review:
Replaces the old review item (732). Can be billed up to once every 3 months. Patient must have had a 965 billed at least 3 months prior. Rebate: $156.55 (equalised with 965). Use reviews to track progress, adjust goals, and renew allied health referrals.
Telehealth equivalents: 92029 (prepare via video), 92030 (review via video).
Item 177 — Health Assessment (45–49 year olds):
One-off health assessment for patients 45–49 at risk. Use to identify and document MetSy and associated risks.
Transition: Patients with existing GPMPs/TCAs from before 1 July 2025 can continue accessing services under those plans until 30 June 2027, after which a GPCCMP is required.