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VA Diabetes Risk Cohort Provides Largest Pool of US Adults Without Diabetes at Baseline

December 10, 2020

The incidence rate of type 2 diabetes in a cohort of more than 6 million US veterans followed a median 5.5 years was 26 per 1000 person-years, researchers reported online in BMJ Open. 

The Veterans Administration Diabetes Risk cohort spans all US veterans enrolled at the Veterans Health Administration between January 2008 and December 2016 without diabetes at enrollment. The current analysis followed the cohort through December 2018. 

Risk factors such as hypertension, hyperlipidemia, and smoking were present at baseline at higher rates among veterans who developed diabetes over follow-up compared with those who did not, according to the report. 

The largest cohort of diabetes-free adults in the United States, the Veterans Administration Diabetes Risk cohort includes veterans from all 50 states. 

“While the main outcome of interest was incidence of type 2 diabetes in this cohort, the infrastructure is well suited to support studies of diabetes management and management of other chronic conditions using incident cases of diabetes, particularly as retention has been shown to be good,” researchers wrote. “During the study period, only 8.5% of the cohort were lost to follow-up and 17.7% died.” 

The large size and long-term follow-up of the national cohort are strengths, as well as its comprehensive set of demographic, clinical, and other variables available in electronic health records, the authors noted. Limitations include data restricted to what is in electronic health records, as well as the predominantly male and white population. 

Researchers plan to use the cohort to study risk factors for diabetes incidence and management at the community level, such as food environments and neighborhood socioeconomic status. 

“This cohort also establishes a baseline against which to assess the impact of national or regional strategies to prevent diabetes in veterans,” the authors wrote. “It also provides an analytic cohort to examine the dynamic relationship between the COVID-19 pandemic and diabetes outcomes.”

Jolynn Tumolo 


Avramovic S, Alemi F, Kanchi R, et al. US veterans administration diabetes risk (VADR) national cohort: cohort profile. BMJ Open. 2020;10(12):e039489. Published 2020 Dec 4. doi:10.1136/bmjopen-2020-039489

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