If you are looking for significant ways to improve your patients’ health this year, you might want to start by tackling the major health issues facing Americans. An upcoming editorial by Ignacio De Artola, Jr., M.D., Keck School of Medicine, University of Southern California, Los Angeles, focuses on the epidemic metabolic syndrome—the triad of type 2 diabetes, dyslipidemia, and hypertension. Type 2 diabetes, dyslipidemia, obesity, or hypertension is rarely seen in isolation and, as the author notes, the prevalence of the metabolic syndrome is estimated as 24 percent and rising.
Watch for the upcoming article by Shobha S. Rao, M.D., Phillip Disraeli, M.D., and Tamara McGregor, M.D., University of Texas Southwestern Medical Center at Dallas, entitled “Impaired Glucose Tolerance and Impaired Fasting Glucose,” which provides an update on lifestyle interventions that can delay or prevent progression to type 2 diabetes in patients with impaired glucose tolerance. Dietary changes, weight loss, and exercise can help head off the development of type 2 diabetes in patients with impaired glucose tolerance and impaired fasting glucose, which indicate an intermediate stage in the development of the disease.
According to the authors, 10 to 15 percent of adults in the United States have impaired glucose tolerance or impaired fasting glucose. Risk factors for diabetes include family history of diabetes, body mass index greater than 25 kg per m2, sedentary lifestyle, hypertension, dyslipidemia, history of gestational diabetes or large-for-gestational-age infant, and polycystic ovary syndrome. The American Academy of Family Physicians recommends screening for type 2 diabetes in patients with hypertension or hyperlipidemia.
Hypertension, like diabetes, has a preclinical stage of development, recently identified as prehypertension by the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7). The “Point-of-Care Guide” in this issue, developed by Mark S. Ebell, M.D., AFP’s deputy editor for evidence-based medicine (see page 1485), offers a two-page evidence-based encounter form for the initial evaluation of patients with hypertension. The form covers a focused history, physical and laboratory examinations, target blood pressures, and lifestyle recommendations.