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Risk factor management in stable, insulin-treated patients with Type 2 diabetes: the Diabetes Outcomes in Veterans Study.
Murata GH, Shah JH, Wendel CS, Hoffman RM, Adam KD, Bokhari SU, Solvas PA, Duckworth WC. Risk factor management in stable, insulin-treated patients with Type 2 diabetes: the Diabetes Outcomes in Veterans Study. Journal of diabetes and its complications. 2003 Jul 1; 17(4):186-91.
OBJECTIVES: Describe the methodologies and study population of the Diabetes Outcomes in Veterans Study (DOVES). RESEARCH DESIGN AND METHODS: Prospective, multicenter, observational study of Southwestern veterans with stable, insulin-treated Type 2 diabetes. Subjects were randomly selected from pharmacy records and were required to be using at least one long-acting insulin preparation daily. Baseline psychosocial evaluations included psychological status, social and cultural barriers to care, self-care behaviors, and vascular disease risk factors. Clinical measurements included self-reported vascular disease, hemoglobin A1c (HbA1c), blood pressure, blood lipids, and body mass index (BMI). A subset of subjects completed a protocol of four times daily self-monitored blood glucose testing for 8 weeks. Subjects were followed for 12 months. Principal endpoints included glycemic control, the occurrence of hypoglycemia, and control of vascular disease risk factors. RESULTS: We enrolled 338 subjects. The mean (+/-S.D.) age was 65.1+/-9.7 years and 3.8% were women. At baseline, over two-thirds of subjects reported vascular disease complications. Nearly three-quarters had limited physical activity. Among subjects younger than 65 years, 53% considered themselves disabled for work. Despite the high prevalence of vascular disease, 43.8% had an HbA1c > / = 8.0%. Many subjects were sedentary, 62.1% had a BMI of 30 kg/m(2) or above, and 22.2% were still smoking. CONCLUSIONS: Detailed measurements of psychological status, self-care behaviors, and risk factor control are feasible in this elderly, debilitated population. Although the prevalence of complications and self-rated disability was high, vascular disease risk factors were poorly controlled in a substantial proportion of subjects.