MILITARY MEDICINE, 184, 7/8:e309, 2019 The Veterans With Diabetes Transition Study. Veterans Experience of the Process of Transition Following Active Duty Diagnosis CDR Mark Malebranche, NC, USN (Ret.)*; CDR Joseph Burkard, NC, USN (Ret.)*; Jane Georges*; David Bittleman† ABSTRACT Introduction: Veterans face several potential difficulties upon leaving active duty. Among these is transition of healthcare to a different setting. The transition from active duty to veteran status is often a challenging time for veterans with diabetes. Changes in healthcare have been shown to decrease diabetes care compliance and dia- betes self-management resulting in exacerbation in diabetes symptoms and increased healthcare expenditure. A seam- less transition in healthcare management from active duty to veteran status has the potential to maintain or increase diabetes self-management. A gap in the literature exists regarding the transition process between healthcare systems, including the DoD and VA. This paper describes the transition experience of a sample of veterans with diabetes from active duty to veteran status. Materials and Methods: A qualitative study was designed to document the experience of veterans diagnosed with diabetes while on active duty. A semi-structured questionnaire developed for the study served to elicit each veteran participant’s general description of the transition process. Quantitative instruments S-TOFHLA and DDS were used as measurements of potential barriers to diabetes self-management and navigating or adjusting to a changed priority within a healthcare system. Results: Two main themes, those of unplanned and undesired end of a military career and feeling prepared to leave the military, were expressed by participants. Four additional themes were also discovered. Responses to quantitative instruments lacked variability and did not allow for further analysis. Specifically, the S-TOFHLA indicated all participants had adequate health literacy and the DDS showed no distress from diabetes. Conclusions: Study participants reported consistent compliance in diabetes self-management. Skills and attitudes obtained during military service led to participant’s desire to manage their healthcare with determination to cope with challenges accompanying diabetes. The healthcare transition process would benefit from additional explora- tion of veteran’s needs. Improved processes may facilitate the healthcare management transition of personnel with dia- betes from active duty to veteran status. INTRODUCTION The transition from active duty to veteran status is often a challenging period for veterans with diabetes. A diagnosis of diabetes while on active duty in the U.S. military is a career changing as well as a lifestyle changing event. Despite case by case review of appeals requesting delay or an exemption from discharge from active duty based upon diagnosis of diabetes, current Department of Defense, Army, Navy, and Air Force regulations list diabetes as a disqualifying condi- tion for service. When an individual is diagnosed with diabe- tes, an incidence of less than 2% of those on active duty, transition from active duty to veteran status is likely. 1–3 This article presents the results of the veterans with diabetes trans- ition study, a qualitative descriptive study of a sample of veterans diagnosed with diabetes while on active duty in the U.S. military and their experience of the transition from active duty to veteran status. This study focused on the trans- ition from healthcare in the Military Health System (MHS) of the Department of Defense (DoD) to healthcare in the Department of Veterans Affairs (VA), healthcare within the DoD as a retiree, or healthcare in another healthcare system. Healthcare transition for active duty service members from MHS healthcare to veterans using other healthcare sys- tems is largely unexplored. Literature on transitions of care focuses, on movement between levels and settings of care and transition of adolescents from pediatric to adult care providers. 4–7 Transition between healthcare systems is not noted in current literature. Transition of active duty ser- vice members with diabetes to veteran status has not been explored. Current literature is primarily focused upon the experi- ence of veterans with psychological or physical combat inju- ries. Such studies describe the real or anticipated difficulties combat veterans may encounter during the active duty to veteran transition. 8–10 Notably, veterans describe life adjust- ments made to deal with post-traumatic stress disorder, trau- matic brain injury, amputation, and loss of comrades. No studies focused on the transition experience of veterans diag- nosed with diabetes on active duty. This study provides data for additional study of the needs of veterans with diabetes. Future research may allow for generation of interventions that support diabetes self-management in this population. *University of San Diego, Hahn School of Nursing and Health Sciences, 5998 Alcala Park, San Diego, CA 92110-2492. †VA San Diego Healthcare System Mission Valley Clinic, 8810 Rio San Diego Drive, San Diego, CA 92108. The views expressed are solely those of the authors and do not reflect the official policy or position of the U.S. Army, U.S. Navy, U.S. Air Force, the Department of Defense, or the U.S. Government. doi: 10.1093/milmed/usy351 © Association of Military Surgeons of the United States 2018. All rights reserved. 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