title: Risk factor management in stable, insulin-treated patients with Type 2 diabetes: the Diabetes Outcomes in Veterans Study.
abstract: OBJECTIVE
  Describe the methodologies and study population of the Diabetes Outcomes in Veterans Study (DOVES).
  
  
  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.
authors.affiliation: Department of Medicine, New Mexico VA Health Care System, Albuquerque, NM 87108, USA. glen.murata@med.va.gov
authors.forename: Glen H
authors.initials: GH
authors.lastname: Murata
authors.forename: Jayendra H
authors.initials: JH
authors.lastname: Shah
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Wendel
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hoffman
authors.forename: Karen D
authors.initials: KD
authors.lastname: Adam
authors.forename: Syed U
authors.initials: SU
authors.lastname: Bokhari
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Solvas
authors.forename: William C
authors.initials: WC
authors.lastname: Duckworth
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D006233:Persons with Disabilities; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking; D016896:Treatment Outcome; D014728:Veterans
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin