Gaps in Prediabetes Documentation Among Veterans: Implications for Primary Care

VA network analysis finds 68% of 105,737 Veterans with HbA1c 5.7–6.4% have no documented prediabetes diagnosis in the EHR — a large, actionable prevention gap.

The cross-sectional analysis of Veterans seen in VISN 6 from 24 June 2023 to 23 June 2025 defined prediabetes as HbA1c 5.7–6.4% and used the VA Corporate Data Warehouse for data extraction. Investigators categorized patients by presence or absence of an ICD-10 R73.xx prediabetes code and applied descriptive and bivariate methods. The sample size strengthens precision; the VISN 6 frame limits national generalizability.

More than two‑thirds of eligible Veterans lacked a documented prediabetes diagnosis. Documentation was more common among Black and female Veterans; White Veterans and those with cardiovascular comorbidities (dyslipidemia, hypertension, heart failure) or certain mental health conditions had lower documentation rates. These associations identify groups for targeted outreach rather than proving causal drivers.

Veterans prescribed metformin and GLP-1 receptor agonists were likelier to have a prediabetes diagnosis recorded. That pattern probably reflects clinician recognition of metabolic risk or coding related to treatment, not a pharmacologic effect on documentation; medication-linked coding therefore functions as a pragmatic case-finding signal.

Practical levers to close the gap include targeted screening for demographics shown to be underdocumented, one-click EHR prompts tied to HbA1c thresholds, structured diagnosis templates, and streamlined referral pathways to VA prevention programs. For example, an automated alert that flags HbA1c values in the 5.7–6.4% range with a single-click order set for diagnosis confirmation and referral could increase recognition and linkage.

Key Takeaways:

• Most Veterans meeting HbA1c–defined prediabetes criteria lack an EHR diagnosis — a missed prevention-referral opportunity.
• Documentation varies by race, sex, and comorbidity; medication exposure (metformin/GLP‑1 agents) identifies a subgroup for targeted case-finding.
• Feasible EHR interventions — alerts, diagnosis templates, and streamlined referral workflows — could increase identification and enrollment in prevention programs.