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As we mark Veterans Day today in honor of those who’ve served our country, we’re a bit alarmed over a recent story out of West Virginia that has sparked a Congressional investigation into problems at the Veterans Administration (VA) nationwide.

It's becoming clear that veterans' healthcare in this country needs an overhaul, and that impacts almost 1.5 million veterans being treated for type 2 diabetes -- 25% of the VA patient population across the country, and growing.

As recently as 2012, the VA was touting its cutting-edge care. But today's headlines are showing some clear failings that must be acknowledged in general, and in particular for veterans with diabetes. 

 

Veterans Die After Getting Insulin They Didn't Need (!)

At a VA hospital in Clarksburg, WV, in April 2018, nearly a dozen veterans died after being injected with insulin they didn't need. Per media reports, several VA doctors came forward to acknowledge that several veterans had experienced severe blood sugar drops without any particular medical causes. The elderly patients were given insulin for no apparent reason, and the severe low blood sugar episodes all proved fatal. Some of the patients did have diabetes, but did not need the doses in question, while other victims did not have the disease at all.

Three of those cases are now being considered homicides, yet VA officials didn't notify the victims' families of this, stating that the status was confidential as part of an "active investigation." Congress is growing increasingly frustrated that no one has been arrested and that the Office of the Inspector General hasn't moved more quickly on this situation since first starting to investigate in June 2018. One veteran's family has filed a lawsuit.

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One of the victims was Air Force veteran George Shaw, in the hospital for symptoms of dehydration, who was given no less than four insulin injections. Similar cases on the same floor show excessive insulin injections for patients who did not need them. In one incident, a nurse tried to give a patient a shot of insulin before his family quickly said, “No, that will kill him.” The man explained that he takes oral diabetes medication, and that insulin shot would be extremely dangerous to his health. Yet the family received a call the next day saying that his health drastically plummeted and he subsequently died. The family was left wondering if the nurse gave the insulin shot despite their plea not to.

A statement released by VA Inspector General Michael J. Missal to media, says that his office "has been working with our federal law enforcement partners to investigate the allegations of potential wrongdoing resulting in patient deaths at the Louis A. Johnson VA Medical Center in Clarksburg, West Virginia."

Meanwhile, Congress has been grilling VA leadership over other incredible issues -- including malpractice and sickening conditions at VA hospitals throughout the nation.

The whole thing is alarming on multiple levels, including the fact that these people who've put their lives on the line for our country are now in danger of dying simply from neglectful healthcare!

As if all that weren't enough, several Republicans stormed out of a House Committee on Veterans’ Affairs hearing in late October after the panel’s Democratic chairman refused to allow them to introduce amendments to a healthcare bill for female veterans.  

“It’s frustrating and it angers me to think this is what this great committee has come to be. I’m embarrassed today to be on the Veterans Affairs committee,” said Rep. Phil Roe, R-Tenn., the ranking Republican on the committee. “I could care less what your political party is when it comes to veterans issues. I just want to help take care of veterans. Today, we didn’t do that. We made a partisan committee out of something that should never have happened.”

Ouch.

 

Diabetes Tools for Veterans

Americans with type 2 diabetes across the board have had trouble accessing continuous glucose monitors (CGM), which are of course the most advanced technology for monitoring diabetes. This is still true for veterans, despite the VA's supposed support of this technology.

The VA appears to get around covering CGM by telling patients on an individual basis that they don't need a CGM, or that the VA is not in a position to help them obtain a device. There's plenty of study data showing how effective CGM can be, so it's a crime, really, to withhold this therapy for people who've devoted their lives to serving this country.

On the flip side, the Department of Veterans Affairs is now offering (as of early 2019) free access to an online specialty clinic providing a diabetes management platform: Virta Health. The Virta program offers dietary guidance, coaching, and access to medical specialists and peer support as part of its individualized treatment program. The main focus of Virta's online program is controlling diabetes through diet, specifically the ketogenic or "keto" diet. This very low-carbohydrate diet has been shown to help people burn fat more easily than other methods.

The choice to work with Virta stems from the fact that roughly 50% of those receiving VA care are considered overweight or obese and at higher risk for type 2 (on top of the 1.5 million already impacted by T2D).

The Virta program provides 24/7 monitoring and care from their team of board-certified providers, working with VA physicians to monitor veterans' conditions, adjusting medications as needed, and developing an individualized care plan. Overall, the program provides veterans with tools to track their progress, including a body-weight scale that uploads data to the app automatically, a blood pressure cuff for some patients, as well as a fingerstick meter with test and ketone strips, lancets, and alcohol swabs. The course usually costs $350, but for veterans it's free through the VA program.

It's effective, we're told by a Virta Health spokesperson.

A new pilot analysis shows that 84% of T2D patients using the VA-offered program for 90 days saw glycemic outcomes below the "diabetes threshold," or a one-point drop in A1C levels. Those improvements also led to a 53% reduction in need for diabetes-specific meds --- including insulin.

In a press released Virta issued specifically for Veterans Day 2019, they highlight the stories of two veterans in particular:

  • Ron, an Air Force veteran who served for 26 years: saw an A1C drop from 6.7% to 5.0% in just three months on the Virta program and no longer needs to take the T2D meds he had been using.
  • Lester, an Army veteran: dropped his fasting BGs from an average 200 mg/dL to 120 mg/dL within two months while simultaneously reducing the medications he needed.

Virta Health says, "Their stories highlight the severe difficulties that people living with T2D experience daily -- and the freedom that is felt when unburdened with the debilitating physical and emotional side effects that are common with the disease."

That's great data to see, and we sure hope they can expand access to this tool while cleaning up VA hospital care for our country's veterans.

 

Robert Vigersky: Distinguished Veteran Impacting Diabetes Care

Dr. Robert Vigersky, U.S. Army retired colonel

It's good to know there are some champions within the world of veterans' diabetes care.

One standout is Dr. Robert Vigersky, a renowned endocrinologist who spent 27 years of his career at the Walter Reed National Military Medical Center. In early 2019, he became the new chief medical officer of Medtronic Diabetes.

Dr. Vigersky is a retired colonel in the U.S. Army Medical Corps who served in Iraq, Korea and Germany inthe 1970s and early 80s.

He left for private practice in 1984 but re-joined the Army in 2000 to establish the influential Diabetes Institute within the Walter Reed Health Care System and become medical director there, focusing his research on the use of technology and decision-support tools to improve outcomes for PWDs (people with diabetes) in the military. He received the Army's prestigious Legion of Merit award in 2009. He's also a past leader of the national Endocrine Society.

Vigersky has said before that the Army offered him more than a civilian physician's packed schedule of increasing patient visits. He found military medical service more fulfilling, where he could focus on diabetes care, research, and teaching at Walter Reed.

"Dr. Vigersky has designed many research studies that have provided important evidence to guide critical practice in both the civilian as well as the military communities," says his colleague Dr. David Klonoff, who leads the Diabetes Technology Society (which coincidentally will be holding its annual meeting in Bethesda, MD, this week). "(Vigersky's) work has definitely raised the level of diabetes care in the U.S."

Vigersky himself points to establishing the VA Diabetes Institute as a career highlight, which he notes is a center of excellence on how to treat diabetes for those in the military. "The Diabetes Institute was meaningful to me because I had the opportunity to build something from scratch. The framework developed there become a program model in both the military and civilian world on how to leverage the expertise of specialists in short supply into the primary care community."

We applaud Vigersky's work of course, even while reports of sub-standard VA medical care cause concern. It seems we need more experts and advocates like Dr. Vigersky who can elevate the level of diabetes care for veterans.

Broad healthcare policy changes are in the works and should be in place by Summer 2020, VA leaders say, and some of those will certainly impact veterans with diabetes.

"Our veterans deserve better and we must give them our best effort because they have given us their best effort through their service," Rep. Jack Bergman, R-Michigan, said in a news report about the Congressional VA hearing recently. "We have to mitigate the risk of future failures."

Hear hear, Sir. We must do better for those who've given service, with or without a failed pancreas.