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Veterans Health Administration


Close to 25 percent of VA Patients Have Diabetes

Two men and a woman look at a computer

Dr. Leonard Pogach, VA Diabetes Program Director (left), reviews Clinical Practice Guideline Criteria with staff.

With Telemedicine, VA is Leader in Diabetes Care

The VA has been recognized as a national leader in preventive care for persons with diabetes, in part due to the innovative use of telemedicine.

In addition to being a significant cause of disability and early death in the US, diabetes is also a leading cause of blindness in adults.

Regular screening for eye problems related to diabetes is important to preserve vision.

Only 60 to 70 percent of persons with diabetes receive timely and appropriate eye care.

To meet this challenge, the VA, through the Office of Telehealth Services, has developed an important program to ensure that patients with diabetes are evaluated at regular intervals for diabetic retinopathy (damage to the eye’s retina that occurs with long-term diabetes).

This program uses state-of-the-art technology to obtain digital retinal images, which are then sent electronically for interpretation by an eye care specialist, called teleretinal imaging.

To date, more than 400 digital retinal cameras have been installed throughout VA, including in large hospitals, community based outpatient clinics, and rural settings.

The images are imported into the electronic medical record system and are available for viewing anywhere the patient receives care within the VA system.

According to Adam Darkins, Chief Consultant for the Office of Telehealth Services, “Diabetic retinopathy is a significant public health problem. The value of screening for diabetic eye disease is well established.

“By increasing access to care through teleretinal imaging we are providing timely and appropriate screening for retinopathy. We anticipate this will prevent vision loss among patients with diabetes.

The VA teleretinal imaging program is one of the largest in the world, and to date has screened more than 500,000 Veteran patients. Patient satisfaction surveys suggest a high level of comfort and convenience with teleretinal imaging.”

Dr. Darkins also noted that, “Access to eye care is often the biggest challenge in any screening initiative. Even within the VA, obstacles to care exist because of geographic, economic, cultural, educational, and other limiting factors.

“Telehealth services offer an option to help overcome many of these obstacles.”

The teleretinal imaging program is another way in which Veterans receive efficient and effective care in the right place at the right time.

Diabetes Alert — Important Reminder to Take Action

“Nearly one in four Veterans receiving care in the VA has diabetes.”

According to Dr. Leonard Pogach, VA’s National Program Director for Diabetes, “This is partly attributable to the older average age of Veterans compared to the general US population.”

The Centers for Disease Control and Prevention estimate that nearly 26 million people or about 8 percent of the US population, have diabetes.

That includes about 11 million persons 65 and older, or about 27 percent of seniors.

In the United Stated, about one-in-four persons with diabetes are not aware that they have the condition.

Dr. Pogach noted that while exact numbers are not available, it is likely that the number is lower for Veterans receiving regular VA primary care.

However, many Veterans of all ages are at risk for diabetes because of the high rate of overweight and obesity, estimated at over 70 percent of Veterans receiving VA care.

Fortunately, a person’s risk for diabetes can be markedly reduced by exercise and weight loss, as demonstrated by the Diabetes Prevention Program, a landmark study published in 2002.

Diabetes Alert for All Veterans

Diabetes Alert Day, which is on March 22nd, kicks off a four week campaign of encouraging all Americans to know their risk for diabetes, and to take action steps to decrease their risk of developing diabetes. Key risk factors include:

  • Family history of diabetes (First degree relative, such as parents or siblings)
  • Member of a high-risk racial/ethnic group (African American, Hispanic American, Native American, Asian American, and Pacific Islander)
  • Pre-diabetes (high fasting blood glucose — ask your doctor)
  • Hypertension (high blood pressure)
  • Low “good cholesterol” (HDL) and high triglycerides
  • Presence of heart or other vascular disease
  • Overweight or Obesity
  • Abdominal obesity
  • Women with polycystic ovarian syndrome
  • History of gestational diabetes mellitus
  • History of delivering babies weighing more than nine pounds
  • Very low physical activity

Fortunately, a person’s risk for diabetes can be markedly reduced by exercise and weight loss, as demonstrated by the Diabetes Prevention Program, a landmark study published in 2002.

Drastic Weight Loss Not Necessary

An individual does not have to achieve drastic weight loss. Losing about 5 percent of one’s weight will help.

In these studies a weight loss and exercise program was more effective than medication in both younger and older individuals. The medication was not effective in persons older than 60.

The VA’s MOVE! Weight Management Program is available to all Veterans who are overweight or obese and for whom weight management is appropriate. It supports Veterans in developing plans that work for them to lose or maintain weight through balanced diet, physical activity, and behavior change approaches.

For the MOVE! program to be tailored to the individual’s needs, the Veteran can complete a 23 item questionnaire. MOVE! is available in multiple convenient formats including group sessions, telephone-based care, and a new home messaging program called TeleMOVE! which uses the telephone line, provides daily support, and is interfaced with a scale for weekly home weigh-ins. Talk with your Primary Care Team about MOVE!.

Although the focus of the Diabetes Alert campaign is to identify individuals at higher risk for developing diabetes, it is important to remind persons who already have diabetes of the importance of weight loss and physical activity in managing diabetes.

Additionally, persons with diabetes or at risk for diabetes should manage other conditions, such as hypertension or high lipid levels, appropriately, and if they have diabetes, they should be screened at regular intervals for early signs of kidney, foot or eye conditions.

The American Diabetes Association provides an online Diabetes Risk Test.

Other sources for important information include:
  National Diabetes Fact Sheet
  National Institute of Diabetes and Digestive and Kidney Diseases
  CDC Diabetes Public Health Resource