'My whole life has changed': Veterans reap benefits of virtual diabetes management
An all-virtual diabetes management program at the Milwaukee VA is seeing great success, with Veterans lowering their A1cs and weight while weaning themselves from insulin and enjoying the benefits of a healthy lifestyle.
“My whole life has changed,” said Veteran Dan Merritt, 63, who saw his weight drop from 250 pounds to 187, while his A1c fell from 9 to under 7. “I’m super happy. I will stay healthy longer.”
Veteran Gary Dieter, 75, agreed.
“Everything was improved by this program,” he said, noting he lost about 30 pounds, saw his blood sugar numbers stabilize and is now eating healthier. “The whole program is just a plus for people like me who need that one-on-one (interaction).”
Headed by Dr. Carlos Mendez, the Virtual Diabetes Optimization Program brings together a team of health professionals — doctor, occupational therapist, dietitian and pharmacist — along with the latest technology to work closely with Veterans struggling with Type 2 diabetes.
During the “boot camp” program, which ranges from 12-24 weeks, Veterans meet regularly via video using the VA Video Connect platform with the team to formulate a plan involving diet, exercise and medication to better control their diabetes.
They are given a Fitbit activity tracker and access to other apps that help them track their meals and blood sugar levels.
The team also has a weekly “huddle” virtually during which they compare notes on the Veterans’ progress, check the data generated by the Fitbits and apps, and tweak recommendations accordingly.
The program’s creation was spurred by the COVID pandemic, Mendez said, noting many diabetic Veterans were unable to make office visits and struggled with dietary choices.
A pilot program saw good results, and by early 2022, Mendez had solid data indicating tremendous success.
“Veterans completing the program showed on average significant improvement in glycemic control (minus 2.5% A1c), weight loss (minus 18.8 pounds, or 7.8%), and decreased total daily insulin doses (minus 72.8%),” he wrote in an abstract about the program.
“This is very innovative — inside and outside the VA,” Mendez said.
Veterans praised the personalized attention the program provides and the teamwork of the Milwaukee VA crew.
“They don’t leave you hanging,” Merritt said. “They are always helping, giving advice and getting you the meds you need. They need more people like these four. They are wonderful.”
“This is a great program,” said Veteran Steve Turner, 59, who upped his exercise regimen and changed his diet due to the program. “If it can change me, it can change anyone.”
Jill Taxman, an occupational therapist who is part of the team, attributes the program’s success to the team approach.
“To come together as a team and talk turkey about patients’ needs … has a major impact,” she said. “Otherwise, we work in silos.”
Pharmacist Jill Hansen agreed.
“We get great results because we meet and talk, and we team with the patient; the patient is part of the team as well.”
Dietitian Kelly Reeser said diabetes is a complicated disease, so the team approach is the best way to tackle it.
“There are so many factors that go into controlling blood sugars, and there are so many things that impact what’s going on. And it’s not the same day-to-day,” she said, noting the team works together to “close the loop” for the Veterans.
“They (Veterans) don’t have to run around looking for answers,” she said. “It’s a really beautiful way for the patients to get what they need.”
While the guidance the team gives isn’t revolutionary, it’s the delivery method, the personalized approach and the constant reinforcement that connects with the Veterans, Mendez said.
“A lot of people think they know how to be healthy, but they haven’t had the proper opportunity to be guided in the process,” he said. “We hold their hands and say, ‘Come on; let’s do this. You’ll be healthy, eat the right things and get the right medication.’”
Reeser agreed.
“There’s nothing groundbreaking that we’re telling them,” she said. “We spend a lot of time talking about which foods raise blood sugar, but I think the biggest thing is just the application and figuring out how to do that. We try to individualize it to each person and each lifestyle.”
Veterans who achieve certain benchmarks “graduate” from the program, but they aren’t cast out alone. The specialists still make periodic checks to make sure they’re continuing their good habits.
“The idea is once they walk on this path with us, they can then walk on their own,” Mendez said.
The program is still small, serving about 12-18 Veterans per session. Those numbers are low in part because there is little funding for the program; Mendez said the team members are sometimes donating their time to take part.
He’d like to see the program grow, and he’d like to start a support group of past graduates who can help other Veterans achieve the same level of success.
“We have a lot of momentum right now, and we want to cement it,” Mendez said. “We have great plans. We want to continue to open the door to benefit more patients.”
“The results we’ve had are really incredible,” Hansen said. “The patients are so happy. They are proud of themselves and so thankful to work with us. This program is making a difference in these people’s lives.”