VA researchers are studying innovative strategies and technologies- including group visits, telemedicine, peer counseling, and Internet-based education and case management-to enhance access to diabetes care and to improve outcomes for patients. In addition, VA researchers are working to develop better ways to prevent or treat diabetes, particularly in special populations such as the elderly, amputees, minorities, spinal cord injured patients, and those with kidney or heart disease.

Examples of VA Research Advances

Screening is cost effective—Early detection of diabetes and pre-diabetes would not only improve Veterans' health but also reduce health care costs, say Atlanta VA researchers. Their model projected costs over three years for 1,259 adults, using three screening methods. Costs for early detection plus treatment were less than the expected costs of treatment that would be given later on.

P2P support—Peer-to-peer support may be more effective than nurse support in controlling blood sugar in diabetic men. Ann Arbor VA and University of Michigan researchers compared outcomes for men who talked with a nurse versus those who talked with a peer in a group setting. In each case, the men talked about diabetes-related issues once a week. After six months, men in the peer group had better blood-sugar control than at the start of the study; those in the nurse-support group ended up with slightly higher sugar levels. In another VA study on peer support, based at the Philadelphia VA Medical Center, African American Veterans with diabetes served as peer mentors to other minority Veterans and were effective at helping their fellow Veterans manage the condition.

Leptin link—Researchers with VA and the University of Washington in Seattle learned that the brain is able to normalize high levels of blood sugar when there is enough leptin in the central nervous system. Leptin is a hormone that plays a key role in appetite and metabolism and has been of great interest to obesity researchers. In animal experiments, the VA and UW scientists observed that leptin action in the brain can drop blood sugar even when there is a severe shortage of insulin, the main hormone that transports sugar from the bloodstream into the cells. The new insight may eventually lead to new treatment strategies.