Va/dod: Recommendations For The Management Of Type 2 Diabetes Mellitus
VA/DoD: Recommendations for the Management of Type 2 Diabetes Mellitus Individualized management should include education, glycemic management plans, target HbA1c, state the guidelines HealthDay News Management of type 2 diabetes should include shared decision making, and patients should be offered individualized diabetes self-management education and glycemic management plans, according to a summary of a clinical practice guideline published online October 23 in the Annals of Internal Medicine. Paul R. Conlin, MD, from the VA Boston Healthcare System in West Roxbury, Massachusetts, and colleagues convened a joint U.S. Department of Veterans Affairs (VA) and US Department of Defense (DoD) Evidence-Based Practice Work Group to develop a guideline for management of type 2 diabetes mellitus. FDA Committee Supports Semaglutide Approval for Type 2 Diabetes The authors provided updates on management within 7 areas: patient-centered care and shared decision making, glycemic biomarkers, target ranges of hemoglobin A1c (HbA1c), individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients, and treatment for patients in the hospital. Patients should be offered individualized diabetes self-management education, as well as individualized glycemic management plans and target ranges for HbA1c. "In summary, the VA/DoD CPG [clinical practice guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events. Conveying complex information in an understandable manner to individual patients and families through a formal process of shared decision maki Continue reading >>
Va Diabetes Ratings | Veterans Resources
Discussion in ' Diabetes ' started by stumpy , Jun 26, 2004 . Requiring more than one daily injection of insulin, restricted 100 diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated.......................... Requiring insulin, restricted diet, and regulation of 60 activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated.................................................... Requiring insulin, restricted diet, and regulation of 40 activities................................................... Requiring insulin and restricted diet, or; oral hypoglycemic 20 agent and restricted diet.................................... Manageable by restricted diet only............................ 10 Note (1): Evaluate compensable complications of diabetes separately unless they are part of the criteria used to support a 100 percent evaluation. Noncompensable complications are considered part of the diabetic process Note (2): When diabetes mellitus has been conclusively diagnosed, do not request a glucose tolerance test solely for I have no idea what you mean by a D&C unless you are having female problems . You must mean Compensation & Pension (C&P) exam. Is that right? The normal procedure is to file a claim for compensation due to service connected (SC) disabilities with the nearest Veterans Admini Continue reading >>
The Va’s Ratings For Diabetes – Explained
Diabetes Mellitus is a condition that runs rampant among the veteran population. Of those particularly affected is the Vietnam Era community. As these veterans approach the years of wisdom, so too does diabetes creep alongside them. There is no shortage of medical literature on the connection between type 2 diabetes and veterans who were exposed to Agent Orange in Vietnam, Korea and Thailand. Indeed, the VA’s 2015 Annual Benefits Report noted diabetes mellitus as the 9th most prevalent service-connected disability of all compensation recipients, with an estimated 431,166 claims awarded. In 2015, there were 1,347,883 compensation recipients of the Vietnam Era, constituting 32% of the veteran population receiving benefits. Do the math and you find that almost 32% of the Vietnam veterans receiving compensation have diabetes mellitus. Interestingly, 411,698 of those individuals are males. Of course, these statistics are only reflective the veterans receiving compensation. Imagine what the statistics would be if they included non-service connected veterans as well! If you are a veteran who is pursuing a compensation claim for type 2 diabetes, or are already receiving compensation for diabetes, you may find it difficult to understand how the VA’s rating system works for diabetes mellitus. The purpose of this post is walk you through the VA’s rating schedule so you know what to look for and what to expect in terms of compensation. Once the VA has ascertained that a veteran’s diabetes mellitus condition is service connected, the raters refer to the rating schedule to determine the level at which the veteran will be paid for that condition. The rating schedule for diabetes is Diagnostic Code (DC) 7913, which breaks down the ratings for diabetes into five levels. Level 1 Continue reading >>
New Strict Standard For Va Diabetes Ratings | Veterans Disability Attorney Blog
VA Diabetes Ratings: Under VA's rating code , a veteran is entitled to a 40% rating for diabetes "[r]equiring insulin, restricted diet, and regulation of activities." A 20% rating shall be assigned for diabetes "[r]equiring insulin and restricted diet, or; oral hypoglycemic agent and restricted diet." A new decision from the U.S. Court of Appeals for the Federal Circuit clarifies that "insulin," as it is used in VA's rating code, means insulin administered exogenously, or from the outside of the body. In Middleton v. Shinseki, No. 2013-7014, slip op. 10-11 (Fed. Cir. Aug. 15, 2013), the Federal Circuit determined that a veteran could not receive a 40% disability rating for his diabetes where his diabetes required restricted diet, regulation of activities, and the use of a drug that produced insulin endogenously (meaning that the drug caused the body to produce insulin). The Federal Circuit also reiterated the longstanding rule that, to meet the requirement for a 40% disability rating, a veteran had to meet all three of the requirements listed in the rating code. One judge dissented. Circuit Judge Plager said that the rating code should be treated more of a guide and not as a hard and fast code. Circuit Judge Plager also highlighted that, where the veteran's disability more nearly approximates the higher disability rating than the lower rating, the higher disability rating should be awarded. If you or someone you care about is currently looking to file or appeal a claim for VA disability benefits including a claim filed on the basis of diabetes contact a veterans disability attorney from Bosley & Bratch to learn more about your case and how our firm can help. Continue reading >>
The Va's Personal Approach To Diabetes | Defense Media Network
Labels: Military Medicine , Veterans Affairs While the population of U.S. veterans is a fairly representative slice of the American population, there are some differences, particularly among veterans enrolled to receive health care in the Veterans Health Administration (VHA). One of the most conspicuous differences is in the prevalence of diabetes, a chronic disease in which the body cannot produce or properly use the metabolic hormone insulin, resulting in elevated blood glucose. According to the U.S. Centers for Disease Control and Prevention, an estimated 30.2 million Americans, 9.4 percent of the population, have diabetes. About 9.9 million, or 40 percent, of persons with diabetes are 65 or older. Of the more than 5.6 million veterans who received care in the VHA through mid-2017, by contrast, more than 1.5 million about 27 percent have diabetes. Among these veterans, about 70 percent are aged 65 or older. Older adults with diabetes often have significant co-existing conditions or complications, a lack of social support, or food insecurity, circumstances that increase the likelihood of hypoglycemic reactions episodes of low blood sugar or insulin shock. While many Americans with diabetes a little over half are estimated to be otherwise healthy, this number is somewhat lower among veterans; about 40 to 45 percent of veterans with diabetes have no serious coexisting disease. The most common form of the disease, type 2 diabetes mellitus, is the leading cause of blindness, end-stage kidney disease, and amputation for VA patients, and often leads to stroke, nerve damage, and contributes to cardiovascular disease the leading cause of death among all persons with diabetes. After a generation of World War II veterans suffered through an era in which the benefit of blood gl Continue reading >>
Overview Of The 2017 Va/dod Clinical Practice Guideline For The Management Of Type 2 Diabetes
Overview of the 2017 VA/DoD Clinical Practice Guideline for the Management of Type 2 Diabetes The 2017 diabetes mellitus guidelines emphasize shared decision making, dietary changes, and HbA1c target range for optimal control of diabetes mellitus. Fed Pract. 2017 October;34(suppl 8):S14-S19 CDR Tschanz is an associate program director at Naval Medical Center San Diego in California. Dr. Watts is the VHA Office of Nursing Services metabolic syndrome & diabetes advisor at Louis Stokes Cleveland VA Medical Center in Ohio. Maj Colburn is a staff endocrinologist at San Antonio Military Medical Center in Texas. Dr. Conlin is chief of the medical service for the VA Boston Healthcare System in Massachusetts. Dr. Pogach is the national director of medicine for the VHA Office of Specialty Care Services. The authors report no actual or potential conflicts of interest with regard to this article. The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner , Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. Diabetes mellitus (DM) is an epidemic in the U.S. More than 30 million people (9.4% of the total population) have DM; type 2 DM (T2SM) accounts for 95% of these cases. 1 The estimated prevalence of DM among individuals aged > 65 years is about 3 times higher at 26%. The prevalence among veterans enrolled in the VA is higher than in the general population; about 25% of VA users have been diagnosed with DM. 2 As a result, DM is the leading cause of blindness, end stage renal disease, amputations, and a significant contributor to myocardial infarction and stroke. Older adults with DM have an increased risk of mortality compared with individuals without DM. 3 In 2012, DM was estimated to cost $ Continue reading >>
Diabetic Vets: Choose Between Disability Compensation Or Medical Treatment.
Diabetic Vets: Choose between disability compensation or medical treatment. Do we Veterans really want lawyers judges driving wedges between us and our doctors? If you are a Veteran with service-connected diabetes, you are going to want to read this Court case. As time passes, treatment of medical conditions changes new technologies, new medicines, and new practices by doctors can greatly affect whether Veterans recover from or are able to live and function with their service-connected disabilities. Unfortunately, the Veteran affairs diabetes guidelines dont consider these new treatments when making determinations of the degree of a Veterans disability. Lets flesh out how that works by comparing the predicament of 2 very similarly situated Veterans: The Veterans diabetes interferes with his ability to work . The Veterans diabetes is very severe: he has been hospitalized 3 times a year in each of the last 3 years for complications from the diabetes. He gets treatment at his local VA Medical Center where he treats diabetes with regulation of activities, a restricted diet and regularly takes insulin injections. VA Determination: Veteran is 60% disabled, and VA should consider entitlement to Schedular TDIU with a 60% rating. Served in the Republic of Vietnam, lost an arm at the Battle of Khe Sanh VA concedes Veteran was exposed to Agent Orange VA agreed Veterans Type II Diabetes was caused by Agent Orange. The Veterans diabetes interferes with his ability to work. The Veterans diabetes is very severe: he has been hospitalized 3 times a year in each of the last 3 years for complications from the diabetes. He gets treatment at his local VA Medical Center where he treats diabetes with regulation of activities, a restricted diet and regularly takes insulin injections. HOWEVER, Continue reading >>
Va Offers Pharmacy Staff Free Diabetes Management Certificate Course
VA Offers Pharmacy Staff Free Diabetes Management Certificate Course Janet Dailey (l) and Katherine Werner (r) discuss the Diabetes Certificate Course at the Federal Pharmacist Forum in Washington this fall. Photo courtesy of Ralph H. Johnson VAMC MYRTLE BEACH, SCA free online certificate course on diabetes made available at the VA and DoD earlier this year already has had more than 550 enrollments and awarded 15 certificates. As of November, at the Federal Pharmacist Forum, the program was made available for pharmacists and other healthcare professionals in the broader federal system. We recognized that offering accreditation in-house in conjunction with specific education and information on how to manage patients with diabetes was a win-win situation for everyone, said program co-developer Katherine Werner, PharmD, of the Ralph H. Johnson VAMC in Myrtle Beach, SC. The field does not need to pay out of pocket for accreditation costs, and the course expands their knowledge in diabetes management and applies the information into clinical practice to patients with a condition that is widely seen. A 2014 Needs Assessment survey conducted by the VHA Pharmacy Benefits Management (PBM) Education Advisory Committee identified diabetes as the No. 1 topic on which pharmacy staff desired additional education and training. More than 11,000 VA pharmacy employees were surveyed, and 2,377 responded. The online format circumvents problems in continuing education commonly cited by survey respondents, including being too busy to undertake training at work (66%), lack of VA travel funds (32%), limited off-duty personal time to participate (29%), lack of VA tuition funds (28%) and lack of organizational support or approval (27%). Pharmacy staff use the Moodle platform to take the self-pa Continue reading >>
Synopsis Of The 2017 U.s. Department Of Veterans Affairs/u.s. Department Of Defense Clinical Practice Guideline: Management Of Type 2 Diabetes Mellitus Free
Abstract Description: In April 2017, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes mellitus. Methods: The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through June 2016, developed an algorithm, and rated recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Recommendations: This synopsis summarizes key features of the guideline in 7 areas: patient-centered care and shared decision making, glycemic biomarkers, hemoglobin A1c target ranges, individualized treatment plans, outpatient pharmacologic treatment, glucose targets for critically ill patients, and treatment of hospitalized patients. Diabetes is the leading cause of major complications, such as end-stage renal disease and lower extremity amputations, and is a significant contributor to ischemic heart disease, stroke, peripheral vascular disease, and vision loss (1). There has been increasing acceptance of the importance of individualizing glycemic management and assessment of risk for adverse events, especially hypoglycemia (2–6). This is of great importance for all patients, especially older adults (aged ≥65 years) with comorbid conditions. In 2013, 12.0 million older adults in the United States had diabetes, comprising 40% of the 30.2 million persons with the disease (7 Continue reading >>
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Va, Dod Release New T2d Clinical Practice Guideline
VA, DoD Release New T2D Clinical Practice Guideline VA, DoD Release New T2D Clinical Practice Guideline With this update, the VA and the DoD hope to communicate the importance of personalized diabetes treatment to clinicians, patients, and policymakers. HealthDay News Management of type 2 diabetes should include shared decision making, and patients should be offered individualized diabetes self-management education and glycemic management plans, according to a summary of a clinical practice guideline published online in the Annals of Internal Medicine. Paul R. Conlin, MD, from the VA Boston Healthcare System in West Roxbury, Massachusetts, and colleagues convened a joint US Department of Veterans Affairs (VA) and US Department of Defense (DoD) Evidence-Based Practice Work Group to develop a guideline for management of type 2 diabetes. The authors provided updates on management within 7 areas: patient-centered care and shared decision making, glycemic biomarkers, target ranges of HbA1c , individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients, and treatment for patients in the hospital. Patients should be offered individualized diabetes self-management education, as well as individualized glycemic management plans and target ranges for HbA1c. T2D Remission, Weigh Loss Associated With Roux-en-Y Surgery "In summary, the VA/DoD CPG [clinical practice guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events. Conveying complex information in an understandable manner to individual patients and families through a formal proc Continue reading >>
Va, Dod Develop Diabetes Clinical Practice Guidelines
VA, DoD Develop Diabetes Clinical Practice Guidelines The US Department of Veterans Affairs (VA) and the US Department of Defense (DoD) have released a joint clinical practice guideline for the management of type 2 diabetes mellitus. The guidelines were based upon a literature review conducted by a panel of multidisciplinary clinicians and the ECRI Institute, and emphasize personalizing treatment based upon evaluation of patient risk and the results of major trials. ____________________________________________________________________ Provide patient-centered care and incorporate shared decisions making Assess patient characteristics and nonglycemic factors when interpreting the results of hemoglobin A1c, fructosamine, and other biomarker testing Set HbA1c target ranges based on absolute reduction in risk for significant microvascular complications Select pharmaceutical agents based on efficacy, contraindications, drug interactions, and comorbidities In summary, the VA/DoD [clinical practice guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events, the authors concluded. Conveying complex information in an understandable manner to individual patients and families through a formal process of shared decision making is thus foundational to setting and revising goals that are meaningful, safe, and achievable in everyday clinical practice. Conlin PR, Colburn J, Aron D, et al. Synopsis of the 2017 U.S. department of veterans affairs/U.S. department of defense clinical practice guideline: management of type 2 diabetes mellitus [published online October 24, 2017]. Ann Intern Med. doi:10.7326/M17 Continue reading >>
Va And Dod Offer Guideline On Managing Type 2 Diabetes With Summary In Annals
ACP Diabetes Monthly | From Annals of Internal Medicine | November 10, 2017 VA and DoD offer guideline on managing type 2 diabetes with summary in Annals The summary describes ways in which the Veterans Affairs/Department of Defense (VA/DoD) guideline differs from recommendations from the American Diabetes Association, the American Geriatrics Society, and the American Association of Clinical Endocrinologists. A clinical practice guideline on management of type 2 diabetes was released by the Department of Veterans Affairs (VA) and Department of Defense (DoD) in April and was recently summarized in Annals of Internal Medicine. The guideline recommends individualized target HbA1c ranges based on patient characteristics and suggests the following ranges if they can be safely achieved: 6% to 7% in patients with a life expectancy of 10 to 15 years or more and no or mild microvascular complications; 7% to 8.5% in most patients with established microvascular or macrovascular conditions, comorbid conditions, or life expectancy of five to 10 years; and 8% to 9% for patients with a life expectancy less than five years, significant comorbid conditions, advanced complications, or difficulties with self-management. The guideline advocates for patient-centered care and strongly encourages clinicians to incorporate shared decision making and partner with their patients. The guideline also recommends assessing individual patient characteristics, including race, ethnicity, and kidney function, when interpreting HbA1c, fructosamine, and other glycemic biomarker testing. Other recommendations in the VA/DoD guideline address nonpharmacologic diabetes treatments, glycemic targets and insulin regimens in the hospital and ICU, and combinations of pharmacologic therapies. The summary, which wa Continue reading >>
Integrating Diabetes Guidelines Into A Telehealth Screening Tool
Integrating Diabetes Guidelines into a Telehealth Screening Tool by Kelly Gervera, DNP, RN, and Barbara Ann Graves, PhD, RN Diabetes is the seventh leading cause of death in the United States and contributes to long-term complications that are costly to healthcare systems. Twenty-five percent of all veterans in the Veterans Health Administration (VHA) have diabetes. The purpose of this article is to describe the development and implementation of a quality improvement project to embed an evidence-based diabetes screening tool, based on Veterans Affairs/Department of Defense diabetes clinical practice guidelines, into the VHA electronic medical record. The objectives of the screening tool were threefold: to promote evidence-based care, to standardize care coordination, and to promote self-management and proper utilization of resources. Record reviews were conducted to evaluate the effectiveness of the screening tool. Results showed an 88 percent increase in the assessment of annual exams and/or labs, a 16.5 percent increase in disease management assessment and offering of services, and a 50 percent increase in goal-setting activity. Key words: diabetes, guidelines, telehealth, screening tool Diabetes is the seventh leading cause of death in the United States and contributes to long-term complications that are costly to the healthcare system. 1 The total estimated healthcare cost related to diabetes care for the general population in the United States in 2013 was $245 billion. 2 Diabetes is the leading cause of blindness in adults age 20 to 74 years, and diabetic retinopathy is linked to 12,000 to 24,000 new cases of blindness each year. 3 In 2008, an estimated 202,290 diabetic patients had dialysis or kidney transplants. 4 Also, 60 percent of all nontrauma lower extremit Continue reading >>
Quality Of Clinical Practice Guidelines For Glycemic Control In Type 2 Diabetes Mellitus
Quality of Clinical Practice Guidelines for Glycemic Control in Type 2 Diabetes Mellitus Haley K. Holmer , Lauren A. Ogden , Brittany U. Burda , Susan L. Norris Affiliation: Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States of America Affiliation: Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States of America Affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon, United States of America Affiliation: Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States of America Several studies have reported that clinical practice guidelines (CPGs) in a variety of clinical areas are of modest or variable quality. The objective of this study was to evaluate the quality of an international cohort of CPGs that provide recommendations on pharmaceutical management of glycemic control in patients with type 2 diabetes mellitus (DM2). We searched the National Guideline Clearinghouse (NGC) on February 15th and June 4th, 2012 for CPGs meeting inclusion criteria. Two independent assessors rated the quality of each CPG using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Twenty-four guidelines were evaluated, and most had high scores for clarity and presentation. However, scope and purpose, stakeholder involvement, rigor of development, and applicability domains varied considerably. The majority of guidelines scored low on editorial independence, and only seven CPGs were based on an underlying systematic review of the evidence. The overall quality of CPGs for glycemic control in DM2 is moderate, but there is substa Continue reading >>
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Va Benefits For Those With Diabetes
About 25 percent of veterans in the United States have diabetes and also have VA (Veterans Administration) benefits. There are many causes of diabetes, ranging from age to lifestyle to possible herbicide exposure during service in the military. Find out more about the VA benefits that could be available for those with diabetes. Basic Info about Veterans with Diabetes The Centers for Disease Control and Prevention estimates around 8 percent of the population has diabetes. About one in four persons do not realize they have the condition. Similarly, almost one in four veterans getting care from the VA has diabetes. Some of the reasons why veterans may have diabetes include advanced age, genetics, becoming more inactive, being overweight or obese, and possible exposure to herbicides during their time of military service. Losing Weight Can Help Veterans with Diabetes Shedding just five percent of your body weight can help you maintain better blood sugar control and reduce the risk of diabetes. Recent studies indicated a weight loss and exercise program is an effective way to combat diabetes in people who are under the age of 60. All veterans who are obese or overweight can participate in the VA MOVE! – Weight Management Program. This program helps veterans create plans that help them lose weight through physical activity, a balanced diet, and lifestyle changes. The veteran completes a questionnaire to have the program tailored to his or her needs. A variety of formats are available, including telephone care and group sessions. TeleMOVE is a new home messaging program that offers daily support via phone, including a scale interface to weigh in each week. The VA also can help those who have diabetes or at risk to manage conditions such as high cholesterol and hypertension. S Continue reading >>
