(Word Version) October 2000 VA Accomplishments in Diabetes Care (http://www.va.gov/health/diabetes/default.htm) Diabetes is a national problem that has reached epidemic proportions, according to the U.S. Centers for Disease Control and Prevention. Almost 16 million Americans -- or nearly six percent of the U.S. population -- have diabetes, but about one-third of them are not aware of their condition. Nearly 800,000 new cases are diagnosed every year. The majority of deaths and hospitalizations related to diabetes are due to cardiovascular complications such as heart attack and stroke. Prevalence of Diabetes in Veterans Diabetes has particular importance for the Department of Veterans Affairs (VA) because the prevalence among VA patients -- one in six, or 16 percent -- is substantially higher than in the general population. Based upon an annual VA patient population of more than 3.1 million, the number of VA patients with diabetes at any time is about 500,000. VA is the largest integrated health care system to provide care to persons with diabetes. Nearly all veterans with diabetes are men; 2.4 percent are women. The largest group of veterans with diabetes is over 65 years of age. With proper treatment and lifestyle changes, many complications such as blindness, amputations, heart disease, kidney failure and premature death can be prevented or delayed. The two most common types of diabetes are Type 1 (previously called insulin-dependent diabetes mellitus or juvenile-onset diabetes), in which the body does not make insulin, and Type 2 (previously called non-insulin dependent diabetes mellitus or adult-onset diabetes), in which the body does not react to insulin normally. Type 2 diabetes accounts for 90-95 percent of diabetes cases. Diabetes is more common in Americans who are older, overweight, not active physically, have a family history of diabetes, African Americans, Hispanic Americans, American Indians, Asian Americans or Pacific Islanders. Screening Policies The VA Diabetes Guidelines suggest testing patients at high risk, based upon symptoms or risk factors for diabetes. Diabetes can be easily diagnosed with a test of blood sugar level at a routine visit or during a complete physical examination. Complications of Diabetes in Veterans The complication rate among veterans with diabetes is under active investigation. Microvascular complications of diabetes can include visual loss, kidney failure and lower extremity complications. Three-fourths of the more than 5,900 lower-extremity amputations that occurred in VA care in 1999 were in patients with diabetes. Quality of Care Regular screenings reduce these complications. Control of blood sugar, blood pressure and cholesterol can reduce an individual’s lifetime risk of these and other serious conditions, such as heart attack and stroke. In 1999, over 93 percent of veterans enrolled in VA health care had a test that measures their average blood sugar level over three months (Hemoglobin A1c test); 67 percent had an annual eye exam; 96 percent had a foot inspection; 73 percent had their cholesterol checked; and 44 percent had their urine protein evaluated. Among veterans who had their cholesterol checked, good cholesterol levels equaled or exceeded those reported in private health care. Compensation To qualify for VA disability compensation, a veteran must have a diagnosis of diabetes and evidence that it began or was aggravated during active duty or within one year of release from duty. VA currently is awarding disability compensation to more than 36,000 veterans with diabetes. On Nov. 9, 2000, VA announced that veterans who served in Vietnam and later contracted adult-onset (Type 2) diabetes may be eligible for disability compensation. VA officials are writing the rules to implement that decision, and eligible veterans would not begin receiving benefits under the new rule until sometime in the year 2001. VA Initiatives VA has made diabetes care a priority ever since it began treating chronic diseases on an outpatient basis several years ago. Its emphasis is multi-focused: 1) patient education; 2) health care provider education and guidelines; 3) epidemiologic assessment; 4) quality of care and 5) basic science, clinician and health services research. Accomplishments include: American Diabetes Association (ADA) recognition of VA patient education programs: VA has more certified programs -- 28 as of June 30, 2000 -- offered at VA medical centers than any other national health care system, federal or private. The ADA is the nation’s largest professional society for diabetes care. VA Diabetes Guidelines for Veterans with Diabetes: First published in March 1997, and revised February 2000, these guidelines were developed in collaboration with the National Diabetes Education Program and other federal agencies. They are the first national guidelines to support recommendations for treatment of diabetes with evidence and to stratify preventive approaches in terms of risk. VA Performance Measures: VA has established a national diabetes registry to permit benchmarking of diabetes outcomes among VA medical facilities. VA uses a peer review program to ensure that the rates of screening in VA medical programs for diabetes-related conditions are among the highest of any health care plan in America. The tests are for eye, kidney and foot problems, as well as for blood sugar values (a test called Hemoglobin A1c) and "bad cholesterol" (low density lipoprotein cholesterol). VA is the first national organization to mandate standardization of Hemoglobin A1c testing for blood sugar. VA has established the Diabetes Quality Enhancement Research Initiative to translate research findings into better care for patients with diabetes. Among its projects are proposals to examine the effectiveness of patient education, data feedback to clinicians and case management in improving outcomes of diabetes. VA recently funded a five-year, multi-site study to determine if tight control of blood sugar will decrease complications such as heart disease and stroke, the major causes of hospitalization and death for people with diabetes. VA has partnered with the American Diabetes Association, the Centers for Disease Control and Prevention, the National Institute of Diabetes and Digestive and Kidney Diseases, the Health Care Financing Administration and the Department of Defense to improve the quality of care for diabetes and reduce the burden of diabetes in America. ### This page has been accessed times since November 7, 2000. VA Home Page / Search / Site Map / Facilities Locator Privacy & Security Statement / Disclaimer / FOIA / Contact the VA If you have specific questions on benefits, etc., please go to VA's Consumer Page. Please send your technical comments on this page to VA Office of Public Affairs.