Editor's Note - Cardiometabolic Supplement February 2014
Primary care has made a significant impact on the prevention of cardiovascular disease—to the tune of 1.1 million deaths averted between 1970 and 20101—but diabetes is on the rise globally and health care professionals need to stay vigilant in early detection and maintenance. This was the message from John E. Andreson, MD, a Nashville-based internist and the then-president of the American Diabetes Association, who delivered a keynote address at the 2013 Primary Care Cardiometabolic Risk Summit (October 18-20, 2013, Las Vegas).
Anderson outlined several challenges that primary care practitioners face including lack of time, competing interests at the time of visit, an episodic/acute care model, absent reimbursement for care coordination, limited resources, and evolving treatment options. In addition, there is an overall decline in the number of residents, physician assistants, and nurse practitioners choosing to practice general internal medicine versus subspecialties that pay more. In 1998, 54% of internal medicine residents went to internal medicine general practice versus 21% in 2009.2 Conversely, in 1998 there was no such thing as a hospitalist and today, there are 20,000 hospitalists and the number is projected to reach 40,000 in the near future.
Despite all that, we are seeing a 19% to 35% decline in cardiovascular deaths across the country.1 Emergency room visits have also declined. Anderson acknowledged better medications and better treatment options played a role, however, “I would argue that this is you and me.”
Reductions in complications from diabetes over the past 15 years include a 50% decrease in amputations, 34% reduction in end-stage kidney disease, and a 24% drop in 10-year coronary disease risk.
In 2007, $174 billion was spent on diabetes treatment. In 2012, that number jumped by 41% to $249 billion.3 “I don’t know of any other disease that is growing at a rate of 8.1% per year,” said Anderson. The prevalence of diabetes, particularly in an older, ethnically diverse society, is today’s reality and a major concern for primary care.
In this special issue, you will find an overview of the four pillars of cardiometabolic risk: diabetes (page 9), dyslipidemia (page 11), obesity (page 16), and comorbidities (page 20). In “A Spoonful of Sugar: Improving Medication Adherence through Behavioral Changes” (page 19) Martha M. Funnell, MS, RN, CDE, offers insight as to why people are not taking their medications and how physicians can better work with the patients. Finally, the Photo Essay (page 14) puts a face on the impact of cardiometabolic risk syndrome.
Remember, the Cardiometabolic Risk Summit 2014 will take place from October 10-12 at Caesars Place in Las Vegas. In addition, CRS Spring—a 1-day regional meeting designed to help physicians translate nutrition and diet into clinicalpractice—will be held on May 31 in New Orleans. Register for both events at www.primarycarecardiometabolic.com.
Managing Editor, Consultant and Consultant360
1. National Institutes of Health. 2012 Chart Book. Available at: http://www.nhibi.nih.gov/resources/docs/2012_ChartBook_508.pdf. Accessed August 22, 2013.
2. Weissman A. Internal medicine in-training examination survey. Office of Research, Planning and Evaluation. American College of Physicians. Personal communications between John Anderson, May 2010. ITE Exam Survey.
3. American Diabetes Association. Diabetes Care. 2013;36(4):917-932,1033-1046.