1611-P: Diabetes by Air, Land, and Sea: Effects of Military Deployment on A1c and BMI

Abstract

United States (U.S.) military service members with diabetes (DM) are restricted from working in austere locations due to concerns over potential glycemic decompensation. However, the policies guiding these duty restrictions may be overcautious and are unsubstantiated by systematic analysis. To address this knowledge gap, we conducted a retrospective study characterizing service members with DM who deployed overseas and analyzed changes in their A1c and BMI before and after deployment. In all branches of the U.S. military (Air Force, Army, Marines, Navy), active duty service members with DM completed 11,206 individual deployments lasting ≥90 days between 2004-2017. Of those, 668 (6%) completed a pre- and post-deployment A1c check within 90 days of departure and repatriation. The majority (81.3%) did not have an A1c check before and/or after deployment. For those with A1c values prior to deployment, 64.5% had an A1c < 7%, 20.2% had an A1c between 7-7.9%, 8.4% had an A1c between 8-8.9%, and 6.9% had an A1c ≥ 9%. Most (61.2%) were taking DM medications, of which metformin was the most common (66.2%), followed by sulfonylureas (22.5%). Despite policy restrictions, 6% deployed on insulin. Coincident hypertension (29%) and lipid disorders (33.1%) were common, but ≤ 1% had microvascular complications. BMI was checked pre- and post-deployment on 3083 individual deployments (28%). Mean A1c and BMI did not significantly change pre- and post-deployment (A1c pre- 6.89% vs. post- 6.93%, p = 0.58; BMI pre- 28.9 kg/m2vs. post- 28.7 kg/m2, p = 0.14). U.S. military medical policies restrict deployments for service members with DM due to a perceived risk of decompensation when medical resources are scarce. However, our data demonstrate that A1c and BMI do not significantly change, suggesting that select service members with DM can maintain adequate glycemic control during deployments. The lack of A1c surveillance for the majority of service members with DM surrounding deployment is concerning and should prompt changes in policy. Disclosure I. Folaron: None. M.W. True: None. J.L. Wardian: None. W.H. Kazanis: None. J.M. Tate: None. T.J. Sauerwein: Speaker's Bureau; Self; AstraZeneca, Merck & Co., Inc. S. Graybill: None. P.G. Clerc: None. C. Jenkins: None.