Analysis of Prediabetes in Veterans: Assessing Diagnosis and Population Characteristics Across a Region of Veterans Affairs Health Care Systems.

Background/

Objectives

Currently, 873,000 patients within the VA Health Administration potentially have prediabetes, based on HbA1c. The primary objective of this analysis was to describe and compare Veterans with and without a documented prediabetes diagnosis, across age, sex, race, rurality, and select comorbidities. Secondary objectives included the following: (1) Identify prediabetes diagnosis documentation trends between the VISN 6 facility complexity and (2) evaluate the relationship between specific prescribed medication classes for Veterans and a documented prediabetes diagnosis.

Methods

Veterans presenting to a VISN 6 VA facility within the past 24 months for at least one visit were identified. Veterans were excluded if they had a documented diabetes diagnosis, an HbA1c > 6.5%, or missing demographic data. Veterans with an HbA1c >/= 5.7% to 6.4% were noted if they had a documented prediabetes diagnosis. Data was analyzed between groups (diagnosis code vs. no diagnosis code) using descriptive analyses not designed for causal inference.

Results

Of the 105,737 Veterans meeting the analysis criteria, over 68% did not have a documented diagnosis. Median age was similar between groups. Black and female Veterans were more likely to have a documented prediabetes diagnosis. Documentation among VISN 6 facilities varied (nearly 28% to over 36%). Those with dyslipidemia, hypertension, or heart failure were less likely to have a documented diagnosis, as well as those with depressive, anxiety, and stress and adjustment disorder diagnoses. Those prescribed metformin or a GLP1 agonist had a higher rate of diagnosis documentation, while over 71% of Veterans prescribed an antipsychotic had no documented diagnosis. There was no linear trend with documentation across facility complexity or rurality.

Conclusions

Most VISN 6 Veterans with prediabetes do not have a documented diagnosis. There is an opportunity to increase provider awareness of prediabetes diagnosis documentation, particularly among at-risk Veterans, to improve type 2 diabetes prevention in Veterans.