In a recent multi-center study comparing diabetes care between VA and non-VA sites, it was determined that care was better managed within VA. This analysis in a National Institutes of Health (NIH)-funded diabetes comparative effectiveness research study was led by Ralph H. Johnson VA endocrinologist and researcher Dr. Hermes Florez.

“Through this study, we’ve found that despite the increased complexity of our VA patients when compared to patients seen in the community, our Veterans receive better diabetes care,” Florez said. “I can personally attest to the high-quality care in the inpatient and outpatient setting since I began working for VA in 1998 and as a physician at the Charleston VA for the last two years.”

Florez says there are six key factors that contribute to this high quality of diabetes care for Veterans both nationwide and at Charleston VA.

First, the Ralph H. Johnson VA Medical Center’s diabetes program has a dedicated nurse navigator. This nurse is part of the interdisciplinary team that manages patients with diabetes. The nurse navigator is integral to the continuity of care Veterans receive and assists by coordinating appointments, completing timely evaluations of diabetes post-discharge, scheduling testing and tracking care.

Second, the organized interdisciplinary team is specially trained in diabetes education.

“The team empowers patients with proper knowledge to make good decisions and have good glucose control,” Florez added.

Third, VA has a unique ability to get information from clinical trials and translate that to bedside and outpatient care quickly. Florez notes there are seamless transitions to clinical care without risky adverse events.

Fourth, there is a wealth of knowledge in VA’s electronic health record (EHR) as VA was one of the first health care systems to roll out an EHR decades ago.

“If a patient had pre-diabetes 10 years ago, we could use the information in the EHR to pinpoint when they developed diabetes and create an individualized treatment plan based on that history and baseline data of that patient,” Florez said.

Fifth, because VA has a long history of treating diabetes as a system, there is a tremendous amount of clinical information within VA related to tailoring treatments for patients. The care team can adjust the patient’s treatment plan based on the Veteran’s degree of functionality, age and other important factors.

Finally, Veterans enrolled in VA care tend to stay within the VA system for years, allowing them to get better diabetes care management over time.

Tackle diabetes before it develops

“It’s a great advantage that, as Veterans relocate, they have options for VA care throughout the country that allows them to stay within our system. We have lots of medical information on that patient for many, many years,” Florez said.

As Florez and VA look toward the future management of diabetes, they are reviewing what interventions help Veterans in that pre-diabetes phase to best preserve the Veteran’s quality of life.

“With a large prevalence of obesity among Veterans, we want to be able to tackle diabetes before it develops and the patient’s health declines,” he added.

The Million Veteran Program, a national research program to learn how genes, lifestyle and military exposures affect health and illness, is also giving VA a tremendous amount of data to manage diseases like diabetes.

Florez also credits a strong and unique academic affiliation with the Medical University of South Carolina (MUSC) as part of Ralph H. Johnson VA’s ability to conduct research in a collaborative way that benefits both Veterans and the general population.

Florez additionally serves at MUSC as chair of the Department of Public Health and the Associate Dean of Population Health.

“With a greater diversity of patients in the community, the platform of collaboration helps better reach minority groups that are expanding in South Carolina,” he said. “Bridging this gap in turn may reduce health disparities.”

By Erin Curran is the deputy public affairs officer at the Charleston VAMC

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Published on Feb. 9, 2022

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  1. Nunya Business February 15, 2022 at 5:54 pm

    Reading the policy, there are parts that seem to be, if not censorship, a desire by the government to control how and what people say on a social media page. The spam and threats (depending on what they are) probably are allowed to be censored/moderated. However, the parts about graphic and obscene language seems to be unconstitutional, as does the parts about attacks on individuals or any organization, i.e. The Department of Veterans Affairs and/or it’s subsidiaries. It is one thing to threaten bodily harm to an individual or physical damage to a building, it is altogether a different thing if someone calls an organization or particular person a jerk, north end of a south bound mule, to go have carnal relations with themselves or maternal figure, and so on. A veteran voicing the truth, or what he/she perceives as the truth, may not be what a government agency or employee wants to hear, but, even if it it crudely said, obscene in your mind, calls employees names, etc on a U.S. official site that invites public participation should not be deciding what is appropriate speech.

    I do not know what was written, but the policy, and the requirement to leave a name puts a chill on the exercise of the First Amendment. As I have said, if it was threatening bodily harm to someone or physical damage to a structure that is one thing. Prohibiting graphic, explicit, and obscene language; not allowing government officials to be called out, and prohibiting comments that are “abusive, hateful, or intended to defame an individual OR ORGANIZATION (emphasis is mine) seemingly is more about protecting the image of the VA than it is about helping veterans. It often seems as if there are more people trying to defend the VA and bad decisions and policies than there are those who might be looking into, at a minimum, the systemic issues raised by people who may not be a eloquent as the VA would like.

    Personally I do not like it when profanity, explicit, or obscene language is used on social media. Name calling is not particular appreciated. I prefer not to have to explain to the kids why people are acting like I try to teach my kids not to do so. That said, the government has no business, unless it can genuinely show a legitimate, and not a made up, let’s throw stuff at the wall to see what sticks type of excuse, to censor speech. This is even if it is on a department’s Hero Wall/page.

  2. Jerry DeFedericis February 11, 2022 at 10:45 pm

    Dear Sir,

    I posted a comment today. Where is it?


    Jerry DeFedericis

    [Editor: Comments posted overnight and during the weekend don’t publish until the workweek, when Vantage Point staff can moderate the comments.]

    • Jerry DeFedericis February 11, 2022 at 10:50 pm

      You mean censorship!

      What is the meaning of moderation? Usually moderation means; “Not in excess”.

      [Editor: Here is the commenting/social media policy: ]

  3. Roger Gordon February 11, 2022 at 6:12 pm

    The VA doctor that I had back in 2012 said nothing about my pre-diabetes. He kept saying that all my lab work was fine. I went to an appointment one day and he said “You are diabetic”, and when I ask what I should do he said that I should try to control it with diet. The whole time that I was seeing him he just kept insisting that I was in great shape and never said that anything was wrong. After he retired a new doctor came in and said, You are Stage 4 Kidney Disease and had been for a few years. I went downtown and found a Kidney doc to help me with my diabetes and kidney disease. I have to see a VA Doc once a year and that’s all I do, I just don’t trust them.

  4. Jerry DeFedericis February 11, 2022 at 4:04 pm

    Dear Sir,

    I use the VA hospital located in North Las Vegas, NV.

    Over all the hospital is great.

    Except for the pharmacy! The pharmacy at the North Las Vegas hospital believes they have the right to deny filling prescriptions written by Doctors or changing the prescriptions written by Doctors. The Pharmacy also believes, if you are not injecting Insulin to control your diabetes, it is not necessary to check your glucose. Also, communication with the Pharmacy is terrible. The Pharmacy rarely answers your inquires.

    I went to the emergency room at the VA Hospital in Springfield Missouri as a Traveling Veteran. What an excellent Emergency Room. I was in and out within two hours. This included all my medications. Including Diabetic test strips that I needed, which the North Las Vegas Hospital refuses to issue to me.

    Thank you,

    Jerry DeFedericis

  5. allan lane February 11, 2022 at 3:33 pm

    Why then,one would ask, did the VA cut the test strips from 50 per month to 50 STRIPS PER YEAR. (YES FOLKS THATS 12 MONTHS)for type 2 diabetes. Pretty hard to test your glucose with one strip per week!

  6. Paul February 11, 2022 at 2:41 pm

    Ran out of Meds. VA doctor was out of country couldn’t get meds. Went to outside doctor to get refill. , after VA doctor returned to U.S. A. refused to refill meds since I had went to outside doctor. VA Sucks !!

  7. Mohammed I Hussain February 11, 2022 at 12:08 pm

    Why can’t VA provide 14 days monitoring system

  8. Eloy Eloy Ortega February 11, 2022 at 9:19 am

    who did they ask that for that i have been out of supplies not the first time it sucks i had a stroke that left me

  9. Kevin Hopkins February 11, 2022 at 8:50 am

    va patient care sucks and drs do not listen to us this is true of the baltimore va

  10. Kevin Hopkins February 11, 2022 at 8:15 am

    this is absolutely not true, i have battled with this for over 2 yrs and my primary care dr only gave me ultimatums to get my A1C down rather than adjust my medication. after seeing a nutritionist i started seeing positive results in only 2 months. va drs tend not to listen to their patents and patient advocates has been no help in this matter

  11. Craig Babits February 10, 2022 at 6:57 pm

    Thankful VA Patient. Craig B. Spfld Mo…. A Laurel and Hardy Thank You from the Heart….Sincerely

    I go for medical assistance to the VA Center in Spfld Mo. I have been going several decades now … like everything else early, early on encountered some speed bumps.. after getting in front of it I am so happy and content I could vomit day glow. Team 8 at the Center here in Spfld. Mo is wonderful, the attention, care and information is top rank. Meds come on time, exams are thorough and I am helped to understand the feed back. I ask questions that I study on prior to my visits
    and received informed answers plus addition related feedback. My body parts are needing the attention I am receiving and I am once again so thankful for all
    the people on Team 8, those who answer the phones, those who check us in for Labs, those who Volunteer at the doorway and and especially the Medical Professionals who help myself and other Vets..

  12. Larry F Fisher February 9, 2022 at 7:11 pm

    I have never seen a VA diabetic monitor. How do I find one?

  13. Grayfox41 February 9, 2022 at 5:26 pm

    I have had some ups and downs with the VA over the years. I have to admit that the problems have not always been the fault of the VA programs. More recently, since 2018, I have been very happy with the limited VA Medical Services I have received. However, I would never feel sufficiently comfortable enough (because of Washington politics) to totally depend VA medical services. The VA medical services I do receive are for a disability; which, I firmly believe, is largely attributable to my military service.

    As an aside, I have found that a degree of proactivity is necessary to keep the wheels turning with many organizations and that applies to community and VA medical services as well.

  14. DISGRUNTLED VETERAN DAVID C. BURDICK ...4967 February 9, 2022 at 10:48 am

    ‘there ” => ”their” possessive pronoun.

    [Editor: I found four “there” in the copy, and all are correct. I found zero references to the possessive.]

  15. DISGRUNTLED VETERAN DAVID C. BURDICK ...4967 February 9, 2022 at 10:46 am

    ”Your comment is awaiting moderation.”

    You mean ”censorship” so you feed FLUFF to the naive Veterans who also put there butts on the line to protect yours… (;>{

    [Editor: Nope. Too much spam, and too many Vets including PII in their comments.]

  16. DISGRUNTLED VETERAN DAVID C. BURDICK ...4967 February 9, 2022 at 10:43 am

    HEY research leaders Ralph H. Johnson VA endocrinologist and researcher Dr. Hermes Florez!!!!!
    You missed me in your so-called FLUFF study!!!!!
    I’ve not seen a PharmD to monitor my glucose regimen for ~5yr.8mo, since Dr. Alice Lynch!!!!!
    I’ve not had an appt. w/ my PCP for ?????…

    Quit patting yourself on the butt.
    Ima Microbiologist; I know scientific experimental methodology.

    VA patient care sucks!!!!!
    VA communication sucks!!!!!

Comments are closed.

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