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VA Treatment Tops Managed Care for Diabetes

Aug 24, 2004

Diabetic patients treated by the country’s long-maligned VA health system got better care than diabetics under managed health care plans. From the study it was found that, VA patients received the recommended care more often.

"A nationally funded health care system can provide excellent quality of care," Dr. Eve A. Kerr, of the VA Ann Arbor Healthcare System and assistant professor of internal medicine at the University of Michigan Medical School, said in a statement.
"The VA has instituted system-wide standards, integrated care, and a way to track and monitor how their patients are doing. Other organizations can learn from the VA and how they achieved their quality improvements over the last 10 years," she added.
Her team studied 1285 patients with diabetes treated at five VA medical centers and 6920 patients treated at 8 commercial managed care health plans.

The researchers looked at whether patients underwent seven standard recommended tests or services annually. These included eye examination, hemoglobin A1c measurement, lipid screening, foot examination, proteinuria screening, advice on aspirin use and influenza vaccination.

They found that 93% of VA patients had an annual hemoglobin A1c test, compared with 83% of managed care patients. Seventy-five percent of VA patients were told how aspirin can prevent heart attack and stroke, compared with 49% of managed care patients.

Ninety-one percent of VA patients had an annual eye exam compared with 75% of managed care patients.

Because she practices in the VA, Dr. Kerr stated that she was not personally surprised by the findings. "I have seen the improvements the VA has made in quality of care first hand. However, for those who aren’t aware of these improvements, and some of my coauthors were not, this finding could be seen as surprising."

"However, we still need to learn more about which of the many changes the VA instituted improve quality the most, so that managed care health plans can implement these in the most cost effective manner," added Dr. Carol Mangione of the University of California Los Angeles, who also worked on the study. Ann Intern Med 2004;141:272-281


There is another form of diabetes called Transient Neonatal Diabetes Mellitus (TNDM). Is a rare form of diabetes that affects approximately 1 in 600,000 newborn babies. Babies born with TNDM initially cannot produce insulin, but symptoms disappear after about 3 months. However two-thirds of those affected will develop diabetes later in life, usually in their teens. The mouse model, developed by the research group headed by Dr Gavin Kelsey, at Babraham. http://www.babraham.ac.uk/