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Diabetes in the Military

by Laura Hieronymus, MSEd, RN, BC-ADM, CDE, and Pamela Rickerson, RN, MSN, CDE

There are no secrets to success. It is the result of preparation, hard work, learning from failure.
—General Dwight D. Eisenhower

Serving in the US military requires a certain level of physical fitness and freedom from any disability “that may require excessive time lost from duty for necessary treatment.” When civilians apply to join the military, therefore, they are required to pass a medical exam and to disclose information about their medical history. While not all medical conditions disqualify a person from joining the military, many do, and any type of diabetes that requires treatment with medication generally does.

Developing diabetes while already serving in the military, however, is not automatic grounds for separation (retirement) from the military. Several hundred service members (out of more than 1.4 million currently serving) are diagnosed with diabetes each year. Between 1997 and 2007, fewer than 6% of diabetes diagnoses were Type 1 diabetes, 80% were Type 2 diabetes, and the remaining 14% were not consistently reported as either Type 1 or Type 2 diabetes. Because active service members have mandatory medical examinations and free access to health care, it is thought that there are few undiagnosed cases of diabetes among military personnel. Service members who develop diabetes and cannot maintain an HbA1c level below 7% without medication are referred to a medical evaluation board, which assesses their medical fitness and makes recommendations about follow-up care.

As is the case for civilians, being overweight or obese puts a service member at higher risk of developing Type 2 diabetes. In 2011, the Armed Forces Health Surveillance Center reported that between January 1998 and December 2010, nearly 400,000 of its active members had at least one overweight-related medical diagnosis. Factors that are most commonly correlated with obesity in enlisted personnel are older age, African-American or Hispanic ethnicity, and being married with the spouse in the household. Furthermore, the average duration of active military service after an overweight-related diagnosis was 15 months shorter than those active members without an overweight-related medical diagnosis. Service members who fail to meet weight standards through reconditioning programs may be ineligible for reenlistment, promotions, career advancement, and professional training.

Military service members with Type 2 diabetes generally have the following characteristics: they are older, have a higher body-mass index, and are less likely to be Caucasian and more likely of African-American or Hispanic American descent. Also, having a history of post-traumatic stress disorder (PTSD), a type of anxiety disorder that can occur as the result of experiencing a life-threatening event, is associated with a higher risk for diabetes.

Promoting healthy habits
Affiliation with the military typically brings about frequent moves, often with little advance notice. It may also involve long separations of the service member from his (or her) family, when he is deployed to active duty. Both of these situations are stressful and may contribute to unhealthful lifestyle patterns as all parties adjust to a new living or family environment.

To help its members stay as healthy as possible, the US military has established a variety of benefits for its service members and their families that support healthy eating behaviors and being physically active. One of these is the system of commissaries, or military grocery stores, that provide grocery shopping in a safe and secure environment in locations around the world. Military shoppers can save an average of 30% or more on food and related items, compared to prices at regular, commercial grocery stores. To help shoppers make healthy choices, the Defense Commissary Agency has initiated the “Eat Healthy — Be Active Your Way!” program, which includes posting nutritional tips throughout its commissaries.

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Also in this article:
Resources for Healthful Eating and Exercise
Veterans Health Administration Resources



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