Trends in diabetes mellitus indicators in veterans with spinal cord injury.

Abstract

Persons with spinal cord injury (SCI) are at increased risk for developing diabetes mellitus (DM). However, published data on the care provided to this population are minimal. The purpose of this study was to examine a set of measures of quality of DM care in veterans with SCI. Retrospective analysis of the External Peer Review Program data for veterans with SCI and DM from 2002 to 2004 in the Veterans Healthcare System. Trends in DM measures were examined using generalized estimation equation models. The percentage of veterans who received testing for lipids, retinal, and renal exams significantly increased during this period. This was accompanied by significant improvements in intermediate outcomes, glycemic, lipid, and blood pressure (BP) control. The percentage of veterans with glycosylated hemoglobin (HbA1c) (levels < or = 9%; P < 0.001) and those with poorly controlled levels (HbA1c > 9.5%; P = 0.022) improved. BP (140/90) rates increased from 59% in fiscal year (FY) 2002 to nearly 70% in 2004 (P < 0.001). The percentage of veterans who received renal screening (anatomical tests, physiologic test, and urine microalbumin) increased significantly (P < 0.001). Retinopathy exam rates also increased from 55.1% in FY 2002 to 70.8% in FY 2004 (P < 0.001). Significant improvements were made in a set of DM measures used to evaluate care provided to veterans with SCI. The positive trends in DM care seen in the general veteran population were also evident in the SCI population.