Risk factor management in stable, insulin-treated patients with Type 2 diabetes: the Diabetes Outcomes in Veterans Study.
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.
Murata
Glen H
GH
Department of Medicine, New Mexico VA Health Care System, Albuquerque, NM 87108, USA. glen.murata@med.va.gov
Shah
Jayendra H
JH
Wendel
Christopher S
CS
Hoffman
Richard M
RM
Adam
Karen D
KD
Bokhari
Syed U
SU
Solvas
Patricia A
PA
Duckworth
William C
WC
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
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin