Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656.
Type 2 or adult-onset diabetes is a major problem in the United States. Sixteen million people have the disease and these numbers are growing alarmingly. Diabetes is a serious health problem, with disastrous consequences: it can cause blindness, kidney failure, nerve damage and heart disease. Cost of treating diabetes and its consequences is estimated at $100 billion per year.
A simple mathematical model, using readily available clinical measurements, predicted who would get type 2 diabetes as well as the standard glucose tolerance test did (Article, p. 575). The model used information on a person's age, sex, ethnicity, and family history of diabetes (factors that cannot be changed) and clinical factors such as high blood pressure, high cholesterol, and body weight (factors that can be changed by lifestyle changes or drug therapy). An alternative for the oral glucose tolerance test is good news for many reasons: type 2 -- or adult diabetes -- can be prevented with lifestyle changes or drug therapy, so identifying people likely to develop diabetes offers the chance to intervene and prevent the disease, and the standard glucose tolerance test is inconvenient and relatively expensive.
There is a big gap between recommended care for diabetes and the care patients actually get in the United States, a new analysis of data from two large national surveys finds (Article, p. 565). Using common standards of good care as benchmarks, researchers found that 18 percent of diabetic patients had poor control of blood sugar, 34 percent had high blood pressure, and 58 percent had high cholesterol.
Treating the victim has been the primary response to violence against intimate partners in the United States. Little attention is given to the person who does the violence, until violence becomes a law-enforcement issue (Current Clinical Issues, p. 637). As long as efforts do not focus on violence prevention, the cycle of battering will continue, experts say. Preventive methods could include counseling batterers after the first incident is identified, before the violence becomes an entrenched pattern, and trying to change a cultural environment that condones aggressiveness and violence, by educating young children about the issue and developing programs for adolescents on dating violence.