Analysis of prediabetes in Veterans: Assessing diagnosis and population characteristics across a region of Veterans Affairs health care systems

Abstract: Background/Objectives: Currently, 873,000 patients within the VA Health Administration potentially have prediabetes, based on HbA1c. The primary objective of this analysis was to describe and compare Veterans with and without a documented prediabetes diagnosis, across age, sex, race, rurality, and select comorbidities. Secondary objectives included the following: (1) Identify prediabetes diagnosis documentation trends between the VISN 6 facility complexity and (2) evaluate the relationship between specific prescribed medication classes for Veterans and a documented prediabetes diagnosis. Methods: Veterans presenting to a VISN 6 VA facility within the past 24 months for at least one visit were identified. Veterans were excluded if they had a documented diabetes diagnosis, an HbA1c > 6.5%, or missing demographic data. Veterans with an HbA1c >/= 5.7% to 6.4% were noted if they had a documented prediabetes diagnosis. Data was analyzed between groups (diagnosis code vs. no diagnosis code) using descriptive analyses not designed for causal inference. Results: Of the 105,737 Veterans meeting the analysis criteria, over 68% did not have a documented diagnosis. Median age was similar between groups. Black and female Veterans were more likely to have a documented prediabetes diagnosis. Documentation among VISN 6 facilities varied (nearly 28% to over 36%). Those with dyslipidemia, hypertension, or heart failure were less likely to have a documented diagnosis, as well as those with depressive, anxiety, and stress and adjustment disorder diagnoses. Those prescribed metformin or a GLP1 agonist had a higher rate of diagnosis documentation, while over 71% of Veterans prescribed an antipsychotic had no documented diagnosis. There was no linear trend with documentation across facility complexity or rurality. Conclusions: Most VISN 6 Veterans with prediabetes do not have a documented diagnosis. There is an opportunity to increase provider awareness of prediabetes diagnosis documentation, particularly among at-risk Veterans, to improve type 2 diabetes prevention in Veterans.