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The Burden of Pre-diabetes Among Overweight and Obese Veterans: Understanding Prevalence of Disease and Merits of Routine Screening

Moin T, Makki F, Weinreb JE, Steinle N, Billington CJ, Havens K, Yancy W, Maciejewski ML, Damschroder LJ, Richardson CR. The Burden of Pre-diabetes Among Overweight and Obese Veterans: Understanding Prevalence of Disease and Merits of Routine Screening. Poster session presented at: Michigan Center for Diabetes Translational Research Symposium; 2014 May 22; Ann Arbor, MI.


Background: Type 2 Diabetes is a preventable disease. Individuals with pre-diabetes can reduce their risk of developing diabetes substantially by improving their diet, increasing their daily physical activity and losing a modest amount of weight. VA/DoD Clinical Practice Guideline (CPG), Centers for Disease Control (CDC), and American Diabetes Association (ADA) all recommend screening for diabetes in high risk patients, and the same tests used to screen for diabetes can also be used to detect pre-diabetes. Veterans with a BMI > 30 or > 25 with other cardiovascular risk factors, many of whom have already been diagnosed with diabetes, are eligible to participate in a group lifestyle program called MOVE! The MOVE! program does not directly address diabetes prevention. While not all veterans who may have pre-diabetes are eligible for MOVE!, those who are referred to MOVE! represent a high risk group. Targeting these veterans for screening may be an efficient way to identify a significant number of veterans with pre-diabetes. Because of the lack of systematic screening, the incidence of pre-diabetes among veterans referred to the MOVE! program is not known. In an effort to decrease incident diabetes among veterans, the Diabetes Quality Enhancement Research Initiative (QUERI) partnered with the VHA National Center for Health Promotion and Disease Prevention (NCP) and clinical investigators from 3 VA sites to implement systematic screening for prediabetes, to estimate the prevalence of pre-diabetes among veterans referred to MOVE!, and to test the feasibility of delivering diabetes prevention focused lifestyle change programs to veterans with pre-diabetes Study Design: Retrospective analysis of data from the VA Diabetes Prevention Clinical Demonstration Project (VA DPP) between 2012-2013. Population Studied: The VA DPP was implemented at three geographically dispersed medical centers beginning in January 2012. All veterans referred to MOVE! or presenting for a MOVE! orientation session who did not already have a diagnosis of diabetes were encouraged to complete a screening hemoglobin A1c (HbA1c) test. Patients were classified as pre-diabetic if their HbA1c value was between 5.7-6.4% with no known history of diabetes and no use of anti-glycemic medications including metformin. All patients were informed of their HbA1c test results and pre-diabetic patients were systematically assigned to either a MOVE! group class or to a diabetes prevention group class. Principal Findings: To our knowledge this is the first study to examine screening practices and the prevalence of pre-diabetes among Veterans in multiple VA sites. The prevalence of pre-diabetes in this cohort of Veterans (23%) was lower than CDC estimates for the general population. However our cohort included only obese Veterans, many of whom already had a prior diagnosis of diabetes or were already using anti-glycemic medications. Conclusions: Almost one quarter of veterans referred to the VA MOVE! program have pre-diabetes and are at high risk for developing diabetes. Implications for Policy and Practice: Screening veterans referred to MOVE! can efficiently identify a significant number of veterans with pre-diabetes. However, the high prevalence of diabetes among MOVE! patients suggests that by waiting until veterans have been referred to MOVE! to screen for pre-diabetes, we may be missing the opportunity to intervene early enough to prevent diabetes in many veterans. While these veterans already have access to a lifestyle change program, it is not a program that specifically addresses diabetes prevention. Optimizing MOVE! for veterans with pre-diabetes or alternatively providing diabetes prevention specific interventions for these veterans may significantly reduce incident diabetes among veterans.

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