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Am Fam Physician. 2004;69(6):1335

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.

Along with the increasing number of persons in the U.S. population at risk for the metabolic syndrome and its consequences, consider the sobering statistics about the uninsured in this country. See the “Medicine and Society” commentary on page 1357 and the accompanying editorial on page 1365.

For your patients who aren’t remaining sober, please see the article about treatment of alcohol withdrawal on page 1443, along with the accompanying collection of patient information handouts on alcoholism starting on page 1497.

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