Physical and psychological functioning in veterans with diabetes: Disease-related versus service-related effects.

Abstract

Objective: Research on veterans with diabetes (VWD) suggested elevated rates of mental illness and substance use disorder but used samples studied 14 -21 years ago without comparator groups. To inform translational research and care-delivery models for diabetes, the purpose of this study was to compare VWD, nonveterans with diabetes (NVWD), and veterans without diabetes (VWOD) on physical and psychological functioning. Method: The study was a retrospective analysis of cross-sectional data from the National Survey on Drug Use and Health, a population-based household-interview survey, 2015 to 2018. Psychological disorders and high-risk substance use were identified with validated scales and standard diagnostic definitions. Results: Regardless of veteran status, diabetes was associated with impaired health: self-rated poor health 9.3% VWD (n ϭ 1,320), 9.0% NVWD (n ϭ 10,246), 3.5% VWOD (n ϭ 8,314); past-year hospitalization 20.4 -23.9% for those with diabetes, 12.9% for VWOD (p Ͻ .001); obesity 49.0 -54.8% for those with diabetes, 31.8% for VWOD. Mental illness was more prevalent in those with diabetes (17.0 -21.8%) than in VWOD (14.8%); high-risk substance use was less prevalent (9.7-9.8% vs. 14.0%, p Ͻ .001). Post hoc analysis by active-duty service era identified high rates of psychological problems, including mental illness (29.7%), among VWD with recent service. Conclusions: Diabetes is associated with similar impairments in veterans and nonveterans. Among VWD, recent service may increase psychological risk. Findings support guideline-recommended patientcentered care for VWD and NVWD. Translational research should assess expansion of Veterans Health Administration (VHA) multidisciplinary disease-and self-management models to non-VHA settings.

Association of Cardiovascular Disease and Military Veteran Status With Impairments in Physical and Psychological Functioning: Retrospective Cross-Sectional Analysis of US National Survey Data

“…25 The VHA's strategic plan describes its "stress [on] preventive interventions" to "eliminate or significantly reduce conditions that impair veteran quality of life," citing diabetes and obesity as examples, but the plan does not mention care for heart disease. 26 If, as previously suggested, the generally equivalent health status of veterans with diabetes, compared with nonveteran counterparts, is due to use of multidisciplinary preventive care strategies, 15 one would not necessarily expect the same favorable outcomes for veterans with heart disease.…”

“…Compared with the US civilian population, veterans are at higher risk of poor physical and mental health and have higher rates of CVD and diabetes. 7,[13][14][15][16][17] Veterans are also more likely than civilians to have been exposed to post-traumatic stress disorder (PTSD); obesity and obesity-related conditions; and, for Persian Gulf and later veterans, environmental contaminants. 14,[18][19][20][21] Thus, they may face greater risks of comorbidity and mortality related to CVD and CVD risk factors than civilian populations do.…”

“…Despite these associations between military service and risk factors for adverse effects of chronic diseases, diabetes was associated with similar physical and psychological impairments in veterans and nonveterans in a previous cross-sectional retrospective analysis of national survey data. 15 Additionally, among those with diabetes, veterans had equivalent or slightly better functioning, defined using standard measures and diagnostic criteria, than did nonveterans. 15 The authors of that study noted that the multidisciplinary team-based care models used by the Veterans Health Administration (VHA) for diabetes and obesity, which include extensive peer-to-peer support and holistic care management, [22][23][24] might explain their findings.…”

“…15 Additionally, among those with diabetes, veterans had equivalent or slightly better functioning, defined using standard measures and diagnostic criteria, than did nonveterans. 15 The authors of that study noted that the multidisciplinary team-based care models used by the Veterans Health Administration (VHA) for diabetes and obesity, which include extensive peer-to-peer support and holistic care management, [22][23][24] might explain their findings. 15 Whether veterans with heart disease have similarly positive functional measures compared with their nonveteran counterparts is unknown.…”

“…15 The authors of that study noted that the multidisciplinary team-based care models used by the Veterans Health Administration (VHA) for diabetes and obesity, which include extensive peer-to-peer support and holistic care management, [22][23][24] might explain their findings. 15 Whether veterans with heart disease have similarly positive functional measures compared with their nonveteran counterparts is unknown. Since about 2005, VHA chronic care improvement initiatives and healthy lifestyle promotion programs have targeted risk factors for CVD, such as diabetes, hypertension, obesity, and substance use disorders, as part of the VHA's strategic focus on disease prevention.…”