Bridging the Know–Do Gap in Metabolic Syndrome Care: A Delphi Consensus Study of Implementation Barriers Among Korean Physicians

Background and Objectives: Metabolic syndrome (MetS) is a prevalent and preventable condition carrying significant cardiovascular risk.While physician awareness is critical for its effective management, systemic barriers persist.This study aimed to evaluate MetS awareness among Korean physicians and identify the structural and systemic barriers impeding the application of its related clinical guidelines in real-world outpatient settings.Methods: We conducted a 2-round modified Delphi survey among board-certified cardiology, endocrinology, family medicine, and pediatrics physicians across Korea.Round 1 (n=202) assessed the participants' familiarity with MetS definitions, use of biometric measurements, and guidelines adherence.Round 2 (n=100) examined consultation time, follow-up patterns, and systemic barriers.Bootstrapped proportions and 95% confidence intervals were calculated for statistical robustness.Consensus was defined as 75% agreement.Results: Physician awareness of MetS diagnostic criteria was high (90.5%);most emphasized lifestyle factors (93.1%).However, routine waist circumference measurements (16.8%) and physical activity monitoring (17.3%) remained infrequent, reflecting a significant know-do gap.The bootstrap analysis confirmed low guideline implementation.Most physicians reported extremely limited consultation time, inconsistent follow-up intervals, and lacking structured tools.Structural time constraints (57.1%), insufficient patient engagement (35.7%), and limited electronic medical records (EMRs)-integrated aids were cited most frequently.