Telemedicine, Internet-based education and case management, group visits and peer counseling are among the strategies Department of Veterans Affairs researchers are studying to increase access to care and improve the health outcomes of patients with diabetes.

VA researchers are seeking better ways to prevent and treat diabetes, especially in special populations including the elderly, minorities, those with amputations or spinal cord injuries, and those with kidney or heart disease.

Diabetes affects about 16 million Americans, including more than 800,000 Veterans receiving care from the VA.

Much of the VA's research focuses on controlling the risk of cardiovascular disease in patients with type 2 diabetes, the most common type. For example, researchers at the Atlanta VA Medical Center are working to stave off progression of the condition before it reaches a full-blown stage.
 
"I think (this project has) extended my life," says veteran Roger Parton, a participant in this research study.

In another diabetes-related study – vision health – the VA and its research partners have demonstrated that veterans could be accurately tested for an eye disease called diabetic retinopathy using a method not requiring eye dilation. The new eye test is helping reduce the risk of blindness in veterans with diabetes throughout the VA's healthcare system, according to VA officials, and the program is now being expanded to evaluate some other important causes of vision loss.

In yet another study that changed diabetes care, researchers at the Miami VA Medical Center looked at whether glucose control affected the rate of cardiovascular disease in those with the disease. This seven-year trial found little reduction in the risk of stroke, heart attack, and other cardiovascular complications, compared with standard treatment. In light of the results of this study and others, major health organizations such as the American Diabetes Association issued new treatment guidance for doctors and patients.

Additional recent advances in VA diabetes research include:

• Promising studies on the connection between insulin resistance – the hallmark of type 2 diabetes – and Alzheimer's disease;
• A determination that, in some people, chromosome 12p is a likely site of genes associated with high triglycerides (a condition closely linked to diabetes, as well as obesity and heart disease);
• Studies finding that walking on a treadmill can prevent and even reverse diabetes in chronic stroke patients.

"This kind of diabetes research is advancing the type of care we're able to give veterans," notes Jennifer Marks, MD, chief of endocrinology at the Miami VA Medical Center and the VA Diabetes Trial's principal investigator. "The care we provide gets better because of research."