b'Servicemembers With Uncontrolled Diabetes Allowed to Remain In MilitarySome Personnel Deployed With HbA1c of 9% or HigherBy Brenda L. MooneyWhile, in general, the U.S. military will not accept recruits Most (84.2%) required diabetes diagnosed with diabetes, that is especially the case withmedications: metformin in 67.3%, patients who use insulin, which is seen as an automaticsulfonylureas in 19.0%, dipeptidyl peptidase-4 inhibitors in 13.9% and disqualification. The situation is different, however, in militaryinsulin in 5.5%. personnel already serving. While most of those retained after Most deployed with an HbA1c diagnosis have well-controlled blood sugar, about one-third haveunder 7.0% (67.1%), with a mean predeployment HbA1c of 6.8%. hemoglobin A1c measures greater than 7%. Thats why theYet, 20% deployed with an HbA1c ability to closely monitor those servicemembers with tools suchbetween 7.0 and 7.9%, 7.2% deployed with an HbA1c between as continuous glucose monitoring is increasingly important.8.0 and 8.9%, and 5.7% deployed with an HbA1c of 9.0% or higher. No significant change in HbA1c FORT SAM HOUSTON, TXIn mostto environments with limited medicalbefore or after deployment was cases, the U.S. military will not acceptsupport, according to the report. documented.recruits with pre-diabetes, Type 1, TypeSan Antonio Military Medical Center- Researcherspointedout,however, 1.5 or Type 2 diabetes. That is espe- led researchers noted the scarcity of datathat those with predeployment HbA1c cially the case with patients who usedescribing how military personnel fareof less than 7.0% experienced a rise in insulin, which is seen as an automaticin those settings, explaining why theyHbA1c from 6.2 to 6.5%, and that those disqualification. conducted a retrospective study analyz- with predeployment HbA1c values of The situation is different, however, ining the changes in glycated hemoglobin7.0% and greater experienced an aver-those already serving. Military person- (HbA1c) and body mass index (BMI)age decline from 8.0 to 7.5%.nelwhohavewell-controlleddiabe- before and after deployment. 1 Duration of deployment appeared to tes and a hemoglobin A1c below 7%ThestudyinMilitaryMedicinehaveaneffect:Thosewhodeployed often are allowed to continue, althoughfoundthatservicememberswithdia- between 91 and 135 days had a decline their roles might be changed to avoidbetescompleted11,325deploymentsin HbA1c from 7.1 to 6.7%, although no deployment. of greater than 90 days from 2005 tosignificant changes were demonstrated A study in Military Medicine pointed2017. Looking at the 474 who had bothin those with longer deployment dura-outthatU.S.militaryservicemem- HbA1c and BMI measurements withintions. At the same time, BMI declined bers have diabetes mellitus at a rate of90 days prior to departure and withinfrom29.6to29.3kg/m 2 (P0.001), 2-3%. And,despitehavingachronic90 days of return, the researchers camewithothersignificantchangesseen medical condition, they have deployedto these conclusions: among those in the Army and Navy and 2020 COMPENDIUM OF FEDERAL MEDICINE 69'