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OtherEditors' Note

Chronic Disease: Increasing Prevalence Yet Better Control

Marjorie A. Bowman and Anne Victoria Neale
The Journal of the American Board of Family Medicine November 2008, 21 (6) 483-484; DOI: https://doi.org/10.3122/jabfm.2008.06.080194
Marjorie A. Bowman
MD, MPA
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Anne Victoria Neale
PhD, MPH
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In this November-December 2008 issue of the Journal of the American Board of Family Medicine (JABFM), we have collected multiple articles related to chronic diseases using methodologies from basic science, epidemiology, and clinical science. As Dr. Parchman1 notes, the prevalence is so great and the complexity so high, that we would all like to quickly cut through the Gordian knot of chronic diseases. In this issue, to highlight the potential impact of chronic disease, Smoley et al2 report some startlingly discouraging data about the amazingly high 75% prevalence of hypertension and prehypertension in a young, fit US military population.

Most of the articles within this issue report findings from primary care offices or population-based data sources, which are particularly useful for family physicians. These include articles on high blood pressure,2,3 kidney disease,4,5 heart disease,6,7 influences on obesity,8,9 adolescents’ obesity,10 negative effects of obesity,11 and diabetes.12 Although our focus is on chronic disease, there is also good news in this issue—we feature articles highlighting just what can be done in family physician offices to improve chronic disease: both hypertension3 and diabetes12 have become better controlled and interventions have improved the prevention of kidney disease.5

The articles related to obesity are particularly exciting. Obesity is increasingly prevalent, has many negative health and social consequences, and is an area of interest for the editorial team. Dr. Bowman has been involved in research to help create lifestyle changes for people with obesity,13 and over the past 3 years, several related papers on obesity have been published in the JABFM.14–19

Perhaps a favorite in the current issue is the article about grandparent/grandchild obesity.8 Possibly genetic, conceivably behavioral, or probably both, the rate of obesity in grandparents, Davis et al8 have now shown, is associated with obesity in children even when both parents are normal weight. In another recent JABFM article, Young et al18 had found that maternal weight is associated with child overweight and also that parents often do not acknowledge that their child is overweight. As family physicians are more likely than other clinicians to see multiple generations of family, they are in a special position to observe these family patterns in practice, and this should cue us to action.

Family physicians may also be cued to action by learning Greenwood et al's9 3 specific eating behavior questions that can be asked of their patients. The 3 behaviors are: eating full portions at restaurants; drinking sugar-containing beverages; and eating fewer fruits and vegetables. These are 3 relatively quick questions and potential areas for behavioral intervention counseling. Fagan et al10 further reports that most overweight and obese adolescents recognize their overweight status and would like to lose weight. We should help them to do so.

Mathew et al6 discuss both the basic science of what is known of the association of obesity itself—not its associated metabolic syndrome—with heart disease and also provides information on the unique associations of obesity with various cardiovascular diseases: heart failure, coronary artery disease, high blood pressure, arrhythmias, strokes, and difficulties in diagnosing heart disease in those with obesity. Mainous et al11 note that elevated liver function tests should make us think of diabetes: this is probably related to steatosis, which is certainly a common problem in people with diabetes and obesity.

In another article with much substance, and much food for thought, Shani et al12 find that good control of diabetes does not occur randomly but is more likely for patients of some physicians than others. First, we should note, overall control of diabetes improved over the time of the study. This is wonderful news. Second, “While some physicians had all their uncontrolled diabetic patients in 2001 become well controlled in 2003, others had none.” Medical directors had a higher percentage of patients become well controlled. Another potentially important fact was that more money was spent for medications in the first year for those patients who became well controlled in the final study year than for those patients who did not become controlled. This may be because greater intensity of medical regimens early may help achieve control as well as signal to the patient that the physician believes excellent control is important, although patient factors also play a role. Patients from the poorly controlled group were also more likely than patients in the well controlled group to change to a different primary care physician (because of patients’ choice or physician replacement). This suggests that continuity of physician–patient relationships are important to the level of diabetes control attained.

Newman7 shows us that stress testing in family medicine offices can have excellent negative predictive value. We also have 2 excellent associated case reports, both pertinent to diabetes: one about a malfunctioning insulin pen,20 and one about a local trauma apparently inducing angiotension-converting enzyme inhibitor-associated edema.21

Notes

  • Conflict of interest: The authors are editors and staff of the JABFM.

References

  1. ↵
    Parchman ML. The Gordian knot of chronic illness care. J Am Board Fam Med 2008; 21(6): 487–9.
    OpenUrlFREE Full Text
  2. ↵
    Smoley BA, Smith NL, Runkle GP. Hypertension in a population of active duty service members. J Am Board Fam Med 2008; 21(6): 504–11.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    Jackson JH, Sobolski J, Krienke R, Wong KS, Frech-Tamas F, Nightengale B. Blood pressure control and pharmacotherapy patterns in the United States before and after the release of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines. J Am Board Fam Med 2008; 21(6): 512–21.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    Naderi AS, Reilly RF. Primary care approach to proteinuria. J Am Board Fam Med 2008; 21(6): 569–74.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    Fox CH, Swanson A, Kahn LS, Glaser K, Murray BM. Improving chronic kidney disease care in primary care practices: an upstate New York practice-based research network (UNYNET) study. J Am Board Fam Med 2008; 21(6): 522–30.
    OpenUrlAbstract/FREE Full Text
  6. ↵
    Mathew B, Francis L, Kayalar A, Cone J. Obesity: effects on cardiovascular disease and its diagnosis. J Am Board Fam Med 2008; 21(6): 562–8.
    OpenUrlAbstract/FREE Full Text
  7. ↵
    Newman RJ, Darrow M, Cummings DM, et al. Predictive value of exercise stress testing in a family medicine population. J Am Board Fam Med 2008; 21(6): 531–8.
    OpenUrlAbstract/FREE Full Text
  8. ↵
    Davis MM, McGonagle K, Schoeni RF, Stafford F. Grandparental and parental obesity influences on childhood overweight: implications for primary care practice. J Am Board Fam Med 2008; 21(6): 549–54.
    OpenUrlAbstract/FREE Full Text
  9. ↵
    Greenwood JLJ, Murtaugh MA, Omura EM, Alder SC, Stanford JB. Creating a clinical screening questionnaire for eating behaviors associated with overweight and obesity. J Am Board Fam Med 2008; 21(6): 539–48.
    OpenUrlAbstract/FREE Full Text
  10. ↵
    Fagan HB, Diamond J, Myers R, Gill JM. Perception, intention, and action in adolescent obesity. J Am Board Fam Med 2008; 21(6): 555–61.
    OpenUrlAbstract/FREE Full Text
  11. ↵
    Mainous AG, Diaz VA, King DE, Everett CJ, Player MS. The relationship of hepatitis antibodies and elevated liver enzymes with impaired fasting glucose and undiagnosed diabetes. J Am Board Fam Med 2008; 21(6): 497–503.
    OpenUrlAbstract/FREE Full Text
  12. ↵
    Shani M, Taylor TR, Vinker S, et al. Characteristics of diabetics with poor glycemic control who achieve good control. J Am Board Fam Med 2008; 21(6): 490–6.
    OpenUrlAbstract/FREE Full Text
  13. ↵
    Kumanyika SK, Shults J, Fassbender J, et al. Outpatient weight managements in African Americans: The Healthy Eating and Lifestyle Program (HELP) Study. Preventive Medicine 2005; 41: 488–502.
    OpenUrlCrossRefPubMed
  14. ↵
    Boardley D, Sherman C, Ambrosetti L, Lewis J. Obesity evaluation and intervention during family medicine well visits. J Am Board Fam Med 2007; 20(3): 252–7.
    OpenUrlAbstract/FREE Full Text
  15. Lutfiyya MN, Garcia R, Dankwa CM, Young T, Lipsky MS. Overweight and obese prevalence rates in African American and Hispanic children: an analysis of data from the 2003–2004 National Survey of Children's Health. J Am Board Fam Med 2008; 21(3): 191–9.
    OpenUrlAbstract/FREE Full Text
  16. Laroche HH, Hofer TP, Davis MM. Adult fat intake associated with the presence of children in households: findings from NHANES III. J Am Board Fam Med 2007; 20(1): 9–15.
    OpenUrlAbstract/FREE Full Text
  17. Gaskins ND, Sloane PD, Mitchell CM, Ammerman A, Ickes SB, Williams CS. Poor nutritional habits: a modifiable predecessor of chronic illness? a North Carolina Family Medicine Research Network (NC-FM-RN) study. J Am Board Fam Med 2007; 20(2): 124–34.
    OpenUrlAbstract/FREE Full Text
  18. ↵
    Young RF, Schwartz KL, Monsur JC, West P, Neale AV. Primary care of overweight children: the importance of parent weight and attitudes about overweight: a MetroNet study. J Am Board Fam Med 2008; 21(4): 361–3.
    OpenUrlAbstract/FREE Full Text
  19. Dicken-Kano R, Bell MM. Pedometers as a means to increase walking and achieve weight loss. J Am Board Fam Med 2006; 19(5): 524–5.
    OpenUrlFREE Full Text
  20. ↵
    Boronat M, García-Delgado Y, Pérez-Martín N, Nóvoa FJ. Severe deterioration of metabolic control caused by malfunction of a disposable insulin pen device. J Am Board Fam Med 2008; 21(6): 575–6.
    OpenUrlAbstract/FREE Full Text
  21. ↵
    Simmons BB, Folsom MA, Bryden LA, Studdiford JS. Angioedema after local trauma in a patient on ACE inhibitor therapy. J Am Board Fam Med 2008; 21(6): 577–9.
    OpenUrlAbstract/FREE Full Text
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The Journal of the American Board of Family Medicine: 21 (6)
The Journal of the American Board of Family Medicine
Vol. 21, Issue 6
November-December 2008
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Chronic Disease: Increasing Prevalence Yet Better Control
Marjorie A. Bowman, Anne Victoria Neale
The Journal of the American Board of Family Medicine Nov 2008, 21 (6) 483-484; DOI: 10.3122/jabfm.2008.06.080194

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Chronic Disease: Increasing Prevalence Yet Better Control
Marjorie A. Bowman, Anne Victoria Neale
The Journal of the American Board of Family Medicine Nov 2008, 21 (6) 483-484; DOI: 10.3122/jabfm.2008.06.080194
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  • Research on the Social Context of Medicine and the Modern Family Physician
  • Improving Health Through Family Medicine: New Opportunities, Missed Opportunities
  • Clinically Relevant Family Medicine Research: Board Certification Updates
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