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primary prevention

Critical Appraisal of Articles on Preventive Health Care

Critical Appraisal of Articles on Preventive Health Care

Teaser: 


Christopher Patterson, MD, FRCPC, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON.
John W. Feightner, MD, MSc, FCFP, Chair, Canadian Task Force on Preventive Health Care; Department of Family Medicine, Faculty of Medicine, University of Western Ontario, London, ON.

The ultimate aim of critical appraisal is to decide whether the conclusions of an article are helpful in the prevention or management of illness in your patients. This requires the article to be relevant to your practice and to contain sufficient information to determine if the conclusions are supported by the evidence within it. We offer approaches to the appraisal of different types of publications addressing primary and secondary prevention.
Key words: prevention (primary, secondary), clinical research, critical appraisal, clinical practice guidelines.

Diagnosis and Management of Impaired Glucose Tolerance and Impaired Fasting Glucose

Diagnosis and Management of Impaired Glucose Tolerance and Impaired Fasting Glucose

Teaser: 


Shobha Rao, MD, Assistant Professor, Department of Family Practice and Community Medicine, UT Southwestern, Dallas, TX, USA.

Impaired glucose tolerance and impaired fasting glucose (prediabetes) form an intermediate stage in the natural history of diabetes. People with prediabetes are at high risk for developing diabetes and thus are a key target group for primary prevention of the disease. A structured program of lifestyle interventions that includes weight loss and regular exercise has demonstrated benefit in delaying or preventing diabetes among people with prediabetes. Lifestyle interventions are most effective. Pharmacotherapy with metformin, acarbose, orlistat, and thiazolidinediones has also shown success in preventing diabetes, although cost effectiveness of these agents in managing prediabetes has not been assessed.

Key words: prediabetes, screening, primary prevention, impaired glucose tolerance, impaired fasting glucose.

Prevention of Diabetes in High-risk Patient Populations, With Application to the Older Population

Prevention of Diabetes in High-risk Patient Populations, With Application to the Older Population

Teaser: 

Ellie Chuang, MD and Mark E. Molitch, MD, Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

The worldwide prevalence of diabetes is expected to double to 300 million people by 2025, and nearly 40% of those currently diabetic are older than 65 years. In those who are at high risk for diabetes, including older adults, intervention with diet and exercise has been shown to markedly reduce the development of diabetes. Medications such as metformin, acarbose, troglitazone, pravastatin, ramipril, losartan and estrogen/progestin also have been shown to be effective, although benefits in older patients have not always been demonstrated. Implementation of lifestyle changes in people of all ages could dramatically reduce the size of the developing diabetes epidemic.
Key words: diabetes, primary prevention, impaired glucose tolerance, impaired fasting glucose, older adults.