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Articles 
Jinan B. Saaddine, Betsy Cadwell, Edward W. Gregg, Michael M. Engelgau, Frank Vinicor, Giuseppina Imperatore, and K. M. Venkat Narayan This study, which used data from several national population-based surveys, found that diabetes processes of care and intermediate outcomes have improved in the past decade. However, 2 in 5 persons with diabetes still have poor control of low-density lipoprotein cholesterol, 1 in 3 persons still has poor blood pressure control, and 1 in 5 persons still has poor glycemic control.
Nicolas Rodondi, Tiffany Peng, Andrew J. Karter, Douglas C. Bauer, Eric Vittinghoff, Simon Tang, Daniel Pettitt, Eve A. Kerr, and Joe V. Selby The authors assessed the care of 253 238 adults who had poorly controlled hypertension, dyslipidemia, or diabetes. The objective was to determine whether poor control triggered changes in treatment and whether these changes were successful. The authors found that many patients with poorly controlled systolic blood pressure (64%), diastolic blood pressure (71%), low-density lipoprotein cholesterol level (56%), or diabetes (66%) did have clinically appropriate changes in their treatment.
Patricia J. Elmer, Eva Obarzanek, William M. Vollmer, Denise Simons-Morton, Victor J. Stevens, Deborah Rohm Young, Pao-Hwa Lin, Catherine Champagne, David W. Harsha, Laura P. Svetkey, Jamy Ard, Phillip J. Brantley, Michael A. Proschan, Thomas P. Erlinger, Lawrence J. Appel for the PREMIER Collaborative Research Group The authors randomly assigned 810 adults with prehypertension or early-stage hypertension to receive advice on changing diet and exercise, a behavioral intervention, or the behavioral intervention plus the Dietary Approaches to Stop Hypertension (DASH) diet. Relative to the advice only group, the odds ratios for having hypertension at 18 months were 0.83 (95% CI, 0.67 to 1.04) for the behavioral intervention group and 0.77 (CI, 0.62 to 0.97) for the behavioral intervention plus DASH group. Absolute blood pressure at 18 months was lower in the behavioral intervention groups, but the difference was not statistically significant.
Jeffrey M. Lyness, Moonseong Heo, Catherine J. Datto, Thomas R. Ten Have, Ira R. Katz, Rebecca Drayer, Charles F. Reynolds, III, George S. Alexopoulos, and Martha L. Bruce In this 1-year observational study of 622 older adults, minor or subsyndromal depression at baseline had functional and depression outcomes that were intermediate between major depression and no depression. Compared with nondepressed patients, those with minor or subsyndromal depression had a 5.5-fold (CI, 3.1-fold to 10.0-fold) increased risk for major depression at 1 year. Most patients with minor and subsyndromal depression did not change or were no longer depressed.
Laure Champion, Marc Stern, Dominique Israël-Biet, Marie-France Mamzer-Bruneel, Marie-Noëlle Peraldi, Henri Kreis, Raphaël Porcher, and Emmanuel Morelon Lymphocytic alveolitis and radiologic bronchiolitis obliterans–organizing pneumonia were the key findings in this series of 24 patients who had renal transplantation and developed sirolimus-associated pneumonitis. Sirolimus withdrawal was associated with recovery within 6 months.
Improving Patient Care
Clement J. McDonald Many hospitals are implementing bar-coding systems to prevent errors in patient identification. In the case described in this paper, which is part of the Quality Grand Rounds series, a diabetic patient was mistakenly given the bar-coded identification wristband of a nondiabetic patient admitted to the hospital at the same time. Although computer systems can improve safety, well-designed, well-implemented processes for cross-checking are also necessary. Health care systems should measure the benefits and potential harms of real-world implementation of computerized patient care systems.
Reviews
Jonathan M. McGavock, Ronald G. Victor, Roger H. Unger, and Lidia S. Szczepaniak Obesity is a major risk factor for heart disease, and physicians must be aware of emerging research of novel mechanisms through which adiposity adversely affects the heart. The purpose of this review is to highlight a novel mechanism by which obesity causes heart disease, whereby excessive lipid accumulation within the myocardium causes left ventricular remodeling and dilated cardiomyopathy.
Editorials
Jonathan B. Perlin and Leonard M. Pogach Clinical trials have shown that better control of glycemia, blood pressure, and low-density lipoprotein cholesterol level leads to better outcomes of diabetes, hypertension, and dyslipidemia. Guidelines have incorporated new evidence very quickly, and national public education programs and professional societies have disseminated these evidence-based recommendations to the public and to professionals. Has this unprecedented momentum created by publicizing evidence and measuring outcomes resulted in translation of evidence into practice? And if not, why? Two studies in this issue provide us with a progress report from both the public health and managed health care plan perspectives.
Kurt Kroenke Lyness and colleagues' study in this issue indicates the potential clinical importance of subsyndromal or mild depression. How can we help patients who seek relief from symptoms of these disorders? A patient-centered approach could reassure the patient that he or she does not have major depression, provide supportive listening, encourage patients to engage in satisfying activities, and engage in problem solving. In a small subset of patients, pharmacologic treatment may be necessary.
On Being a Doctor
Andrea A. Peterson Tonight a girl, 8 years old or so, lies unresponsive in the emergency department. I do not treat children. They are small, and they seem fragile and medically mysterious to me. I do not know how to dose their medications properly without looking them up. I worry that there may be many other things about children that I do not know.
Letters Efficacy and Safety of Inhaled Insulin Therapy
Julio Rosenstock, Bernard Zinman, Liam J. Murphy, Stephen C. Clement, Paul Moore, C. Keith Bowering, Rosa Hendler, Shu-Ping Lan, and William T. Cefalu—RESPONSE Survivor Costs in Cost-Effectiveness Analysis
Evidence for Vascular Spread of Varicella Zoster–Associated Vasculopathy
Reconstitution of Hematin for Intravenous Infusion
Correction: Combination Pharmacotherapy for Cardiovascular Disease
William Rifkin
Ronald A. Carson
Bonnie Salomon
J. E. Babin
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