Management of Type 2 Diabetes Mellitus: Synopsis of the Department of Veterans Affairs and Department of Defense Clinical Practice Guideline.

The US Department of Veterans Affairs (VA) and the US Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes. This was the product of a multidisciplinary guideline development committee composed of clinicians from both the VA and the DoD and was overseen by the VA/DoD Evidence Based Practice Work Group. The development process conformed to the standards for trustworthy guidelines as established by the National Academy of Medicine. The guideline development committee developed 12 key questions to guide an evidence synthesis. An independent third party identified relevant randomized controlled trials and systematic reviews that were published from January 2016 through April 2022. This evidence synthesis served as the basis for drafting recommendations. Twenty-six recommendations were generated and rated by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Two algorithms were developed to guide clinical decision-making. This synopsis summarizes key aspects of the VA/DoD Clinical Practice Guideline for diabetes in 5 areas: prediabetes, screening for co-occurring conditions, diabetes self-management education and support, glycemic treatment goals, and pharmacotherapy. The guideline is designed to help clinicians and patients make informed treatment decisions to optimize health outcomes and quality of life and to align with patient-centered goals of care.

A Randomized Controlled Trial of Nurse Coaching vs. Herbal Supplementation for Weight Reduction in Soldiers.

The number of overweight and obese service members has tripled since the beginning of Overseas Contingency Operations.1 Overwhelming evidence suggesting links between obesity and increased risk for conditions such as musculoskeletal injuries, type II diabetes, and cardiovascular disease,2 poses a threat to the strength and performance of our current and future fighting force. OBJECTIVE: The purpose of the study was to test nurse health coaching (NHC) and/or herbal supplementation for weight reduction in Soldiers during a 12-week intervention. METHODS: Body composition, biomarkers, adherence, and motivation were measured at three time points. The NHC provided a weekly scripted interaction. Change scores were compared across study groups using general linear models. RESULTS: Sample demographics (N = 435): mean age 30 ± 8.2 years, 73.4% men, predominantly white (70.1%) and non-Hispanic (80%), 71% married, and 91% enlisted. Results represent the 3 NHC groups compared to control group. Beneficial intervention effects were observed for heel bone mineral density (d = 0.3), 25-Hydroxyvitamin D (d = 0.43), and fasting blood sugar (d = -0.4), but were not significant following application of a 10% false discovery rate. There were no significant findings for any other comparisons. CONCLUSION: Weight loss proved difficult for all groups; there was no advantage of NHC over an herbal supplement as adjuncts to Army MOVE! for weight reduction. Highly motivated Soldiers were unable to sustain weight loss or body composition changes.

The consequences of modern military deployment on calcium status and bone health.

This article highlights the potential negative effect of the current combat environment on bone health of young military men and women who may be at risk for stress fractures and future bone disease because of alterations primarily in diet and physical activity level during deployment. A combination of physiologic biomarkers, including bone turnover and bone mineral density, and nutrition and exercise surveys can provide meaningful data on potential health risks related to deployment. Soldiers participating in an investigation into bone health before and after deployment did not have decreased bone density but the study did raise awareness about an issue that might otherwise go unnoticed because preventive care is typically focused on older adults. Several risk factors may be modifiable and nurses have the necessary skills for counseling and monitoring behaviors that can minimize disabling musculoskeletal injuries that affect quality of life for the individual and unit readiness for the commander.