Annals Journal Club: Acanthosis Nigricans and Diabetes Risk Factors
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The *Annals of Family Medicine* encourages readers to develop the learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club, and sharing the results of your discussions in the *Annals* online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care, and then acting on those discussions.1

## HOW IT WORKS

In each issue, the *Annals* selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials, and to post a summary of your conversation in our online discussion. (Open the article online and click on “TRACK Comments: Submit a response.”) You can find discussion questions and more information online at: [http://www.AnnFamMed.org/misc/AJC.shtml](http://www.AnnFamMed.org/misc/AJC.shtml).

## CURRENT SELECTION

### Article for Discussion

Kong AS, Williams RL, Smith M, et al, on behalf of RIOS Net Clinicians. Acanthosis nigricans and diabetes risk factors: prevalence in young persons seen in Southwestern US primary care practices. Ann Fam Med. 2007;5(3):202–208.[Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiNS8zLzIwMiI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vNS8zL2lpaS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

### Discussion Tips

This article presents opportunities for many levels of learning about diabetes, diagnostic testing, and practice-based network (PBRN) research. (See the article by Tierney et al in this issue of *Annals*2 for an overview of US PBRNs). You can examine Supplemental Figure 1 online to see what acanthosis nigricans looks like.

### Discussion Questions

*   What are the research questions and why are they important? What already is known about acanthosis nigricans and diabetes risk factors?

*   What are the limitations of the cross-sectional study design for answering the different study questions?

*   To what degree are the findings affected by:
    
    1.  How participants (practices, clinicians,3 patients4,5) were selected?
    
    2.  How critical variables were measured and/or defined?
    
    3.  Missing data?
    
    4.  Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a third factor)?
    
    5.  Chance?

*   What are the main findings? How do they advance current knowledge?

*   How do you interpret the “unanticipated finding”?

*   How transportable are the findings to your setting and patients? How might the information be used to change practice?

*   © 2007 Annals of Family Medicine, Inc.

## REFERENCES

1.  Stange KC, Miller WL, McLellan LA, et al. *Annals* Journal Club: It’s time to get RADICAL. Ann Fam Med. 2006;4(3):196–197. [http://annfammed.org/cgi/content/full/4/3/196](http://annfammed.org/cgi/content/full/4/3/196).
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiNC8zLzE5NiI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vNS8zL2lpaS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  Tierney WM, Oppenheimer CC, Hudson BL, et al. A national survey of primary care practice-based research networks. Ann Fam Med. 2007;5(3):242–250.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiNS8zLzI0MiI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vNS8zL2lpaS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

3.  Nutting PA, Baier M, Werner JJ, Cutter G, Reed FM, Orzano AJ. Practice patterns of family physicians in practice-based research networks: a report from ASPN. Ambulatory Sentinel Practice Network. J Am Board Fam Pract. 1999;12(4):278–284.
    
    [PubMed](http://www.annfammed.org/lookup/external-ref?access_num=10477192&link_type=MED&atom=%2Fannalsfm%2F5%2F3%2Fiii.atom) 

4.  Gilchrist V, Miller R, Gillanders W, et al. Does family practice at residency teaching sites reflect community practice? J Fam Pract. 1993;37(6):555–563.
    
    [PubMed](http://www.annfammed.org/lookup/external-ref?access_num=8245806&link_type=MED&atom=%2Fannalsfm%2F5%2F3%2Fiii.atom) 
    
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5.  Green LA, Miller RS, Reed FM, Iverson DC, Barley GE. How representative of typical practice are practice-based research networks? A report from the Ambulatory Sentinel Practice Network (ASPN). Arch Fam Med. 1993;2(9):939–949.
    
    [CrossRef](http://www.annfammed.org/lookup/external-ref?access_num=10.1001/archfami.1993.01850100059010&link_type=DOI) 
    
    [PubMed](http://www.annfammed.org/lookup/external-ref?access_num=8111525&link_type=MED&atom=%2Fannalsfm%2F5%2F3%2Fiii.atom)