Diabetes care among veteran women with disability

Objective: The primary objective of this study was to analyze predictors of diabetes care consistent with performance standards among women Veterans Health Administration (VHA) clinic users with disability enrollment status. Methods: This is a retrospective cohort study using VHA and Medicare files of VHA clinic users with diabetes. Diabetes care measures consisted of annual testing for hemoglobin A_1c (HbA_1c), low-density lipoprotein cholesterol (LDL-C), and poor HbA_1c (>9%) and LDL-C (≥130 mg/dL) control in fiscal year 2000. Chi-square tests and logistic regressions were used to assess subgroup differences in diabetes care. Independent variables included demographic characteristics and physical and psychiatric comorbidities. Population: Study population was based on veteran women <65 years of age who used VHA clinics; we identified 2,344 women as having coexisting disability and diabetes and 2,766 women with diabetes and without disability. Findings: Among veteran women with diabetes and disability, 65% received ≥1 HbA_1c test, and 54% received a LDL-C test; 25% and 30% had poor HbA_1c and LDL-C control, respectively. In logistic regressions, none of the independent variables had significant effects on poor HbA_1c or LDL-C control, except that African Americans were more likely to have poor HbA_1c control than whites. Significant age effects were noted in rates of HbA_1c and LDL testing. Comparison of diabetes care measures between women with and without disability indicated that those with disability were more likely to receive HbA_1c and LDL-C tests; no significant differences in HbA_1c and LDL-C control were noted. Conclusions: Disability status of women veterans was not a barrier to diabetes care consistent with performance standards. Our findings suggest that to improve diabetes care, subgroup-specific interventions, rather than a global approach, are warranted.