PHOTO BY ALAN LEVINE
V E TE R AN S AFFAI R S & M I LITARY M E D I CI N E O UTLO O K
activities: telemonitoring; a self-management support module for educating patients; diet and activity support, which will help patients develop individualized plans for nutrition and exercise; depression support, linking patients with active depression symptoms to VA resources; and medication management, done in coordination with a VA provider. “It’s very comprehensive,” Crowley said, “and targets many of the factors that typically underlie persistently poor control in veterans with type 2 diabetes.” Crowley’s team is on track to complete enrollment by the end of 2019 and begin reporting data sometime next year. While his team is working blind and can’t predict what they’ll see, he said, “We would consider a clinically significant difference between the two
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An at-home hemoglobin A1c testing device. Diabetes is largely managed by the patients themselves, but research is underway to determine the most effective ways the VA can help patients control the illness.
interventions to be about half a point in A1c. In some of our pilot work, we saw improvements that were substantially greater than that, so we hope we’ll see similar results in this larger study.”
DIABETES CARE FOR WOMEN AND MINORITY VETERANS VA’s attempt to optimize diabetes care for veterans is complicated by the fact that differences – in incidence of the disease, access to care, and outcomes – persist among subgroups of
the veteran population. Researchers throughout the VA conduct numerous studies devoted to mitigating or eliminating these disparities. The fastest-growing segment of VA health care users is women. In 1988, when the VA established its Women Veterans Health Program, a little over 4 percent of veterans were women. Today, the VA estimates that percentage to be 10 percent. Much of what VA investigators have learned about diabetes care for women veterans has been revealed in their examinations of different interventions and models of care. Tannaz Moin, MD, an endocrinologist at the VA Greater Los Angeles Healthcare System, core investigator at the HSR&D Center for the Study of Healthcare Innovation, Implementation
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