Virtual Diabetes Optimization Program (VDOP) for Veterans With Uncontrolled Diabetes

OBJECTIVE More than 25% of U.S. veterans have diabetes, and 78% have a BMI ≥25 kg/m2. Despite access to lifestyle interventions and specialty endocrine care through the Department of Veterans Affairs (VA), many veterans with uncontrolled diabetes and obesity do not achieve sustained glycemic control or weight loss. We developed the Virtual Diabetes Optimization Program (VDOP), a quality improvement initiative targeting veterans with uncontrolled diabetes (glycated hemoglobin A1c [HbA1c] ≥8% [≥64 mmol/mol]) with or without obesity. RESEARCH DESIGN AND METHODS VDOP used a multidisciplinary team—including a registered dietitian, occupational therapist, and clinical pharmacist—delivering frequent virtual care under physician diabetologist supervision. Outcomes were compared with veterans who declined VDOP and received standard endocrine care during the same period. Primary outcomes were changes in HbA1c and body weight at 6 and 12 months. RESULTS A total of 39 veterans completed VDOP and 62 received standard care. Baseline characteristics were similar, though VDOP participants had higher BMI. After 6 months, VDOP participants had significantly greater mean reductions in HbA1c compared with those receiving standard care (mean HbA1c decreased from 9.8% [84 mmol/mol] to 7.1% [54 mmol/mol] vs. 10.6% [92 mmol/mol] to 8.2% [66 mmol/mol]) and greater percent weight loss (−6.8% vs. −0.7%), with these differences remaining significant at 12 months. Differences remained significant after adjustment for baseline values and diabetes medications, including glucagon-like peptide 1 receptor agonists. CONCLUSIONS VDOP was associated with greater improvements in glycemic control and weight loss compared with standard endocrine care. Prospective studies are needed to assess long-term outcomes and cost-effectiveness.