b'Servicemembers With Uncontrolled Diabetes Allowed to Remain In Militarydeployment durations up to 315 days. pointed out that continuation of militaryDoDhealthcareprovidertodeter-Most SMs had an HbA1c 7.0%, sug- service is possible among active dutymine whether a servicemember with a gesting that military providers appropri- servicememberswhentheydevelopchronic medical condition can deploy atelyselectedwell-managedSMsforchronicmedicalconditions,suchasbased on the severity and stability of deployment,theauthorsconcluded.diabetesmellitus,althoughmultiplethe condition, as well as the environ-HbA1c did not seem to deteriorate dur- factorsaffectthisdecision,includingmentandotheranticipatedrequire-ing deployment, but they also did notoccupation and severity of disease. ments in deployment, according to the improve despite a reduction in BMI. authors, who added, It is logical that The study team added, Concerningd uTyr esTricTions diabetes is specifically identified in the trends included the deployment of someAlthoughmostmilitaryprovidersDoD [issuances]I as a high-risk condi-SMs with much higher HbA1c, utiliza- areawarethatdutyrestrictionsandtion since both disease decompensation tion of medications with adverse safetyretainabilitystandardsapplyforanyandcertaindiabetesmedicationscan profiles,andthelackofHbA1candSM with a chronic medical condition,cause incapacitation.BMIevaluationproximaltodeploy- itisnotasubiquitouslyknownthat ment departures and returns. However,some have not only been retained inc onTinuousm oniToringforSMsmeetingadequateglycemicactive duty but have also deployed,Recognizingthatactive dutyservice-targets,wedemonstratedthatHbA1cthe researchers wrote. They explainedmembers, as well as their families and remained stable, supporting the notionthat a waiver enabling deployment isretirees, have diabetes, TRICARE be-thatsomeSMsmaysafelydeploypermissibleasoutlinedbytheDoD,gan providing continuous glucose mon-withdiabetes.ImprovementinBMIstating that servicemembers with dia- itoring for members with uncontrolled may compensate for factors promotingbetes can participate in contingencyType 2 diabetes at the beginning of this hyperglycemiainadeployedsetting,deployments.Thatisdefinedasayear.suchaschangesindietandmedica- deployment that is limited to outsidePreviously,thedeviceswereautho-tion availability. Future research shouldthecontinentalUnitedStates,morerized only in limited circumstances for analyze in a prospective fashion, wherethan 30 days in duration and in a lo- those with Type 1 diabetes.a more complete array of diabetes andcation with medical support from onlyAllowed are continuous glucose mon-readiness-related measures to compre- temporary military medical treatmentitoring system devices approved by the hensively evaluate the safety of deploy- facilities. Food and Drug Administration as long ing SMs with diabetes. The guidance requires a minimum ofas a physician documents: Background information in the articlea medical record review by a trained Poor diabetic control after six months of multiple daily insulin Figure 1 Case selection for analysis, by service, followed byinjections or insulin pump therapy,presence of HbA1c and BMI data. *percentage . Blood glucose self-testing at least four times a day, Completion of a diabetic education program.Patients are required to have HBA1c greater than 7.0% or less than 4.0%, as well as a history of unexplained large fluctuationsindailyglucosevalues beforemeals,historyofearlymorn-ingfastinghyperglycemia,ordawn phenomenon, and/or history of severe glycemic excursions.Thedevicesareintendedfor Source: Mil Med, Volume 185, Issue 3-4, March-April 2020, Pages 486492, https://doi.org/10.1093/milmed/usz311 TRICAREbeneficiarieswith 702020 COMPENDIUM OF FEDERAL MEDICINEMil Med, Volume 185, Issue 3-4, March-April 2020, Pages 486492, https://doi.org/10.1093/milmed/usz311 The content of this slide may be subject to copyright: please see the slide notes for details.'