Diabetes mellitus (DM) is the seventh leading cause of death in the U.S., but after decades of rapid growth, both the incidence and prevalence appear to have leveled off. The VA spends $1.5 billion annually to treat patients with DM. Veterans are 2.5 times more likely than nonveterans to have diabetes, and many have comorbid conditions, including obesity, hypoglycemia, hypertension, dyslipidemia, cardiovascular disease, stroke, blindness, kidney disease, and amputations. Obesity and DM remain closely related, and more than two-thirds of women veterans with DM also have obesity.
A number of factors seem to increase the risk of type 2 DM for veterans. For example, DM is associated with exposure to herbicides, such as Agent Orange; past physical strain with chronic pain, and degenerative joint damage. Certain factors also increase risk of obesity, such as advanced age and low income, as well as limited access to healthy and high-quality foods. High-risk ethnic groups for diabetes include African Americans, Hispanics, Native Americans, Asians, and Pacific Islanders. Veterans with prediabetes, hypertension, low highdensity lipoprotein cholesterol levels, high triglyceride levels, and insufficient physical activity also are at increased risk.
