Overall glucose control in veterans with pharmacologically-treated diabetes mellitus (RxDM) in VANCHCS improved between 1992 and 2004 with mean clinic HbA1c, adjusted to current HPLC methodology, decreasing from 8.7% to 7.5% (n increasing from 2523 to 8334). VA Clinical Practice Guidelines recommend an HbA1c under 9% for all. Extracting from the VA VISTA database, we found that in the year from July 1, 2003 ending June 30, 2004, 1029 veterans (18.3% of those tested; “HiHbA”group) failed to meet this goal (mean HbA1c of 10.4% ± 1.7% SD) and another 1700 (20.4%) were untested for HbA1c. Only 43% (n=444) of the HiHbA received insulin. Of those on oral hypoglycemics alone (n=585), the average number of classes of these agents received during the year was 1.84. Only 25% of the HiHbA group had seen one of our endocrinologists during the year. Only 24% had LDL cholesterol documented under 100 mg/dl and 85% were overweight or obese (BMI ≥ 25). The HiHbA group was younger by almost 7 years (59.6 ± 10.3 vs 66.4 ± 10.9; p≤0.0001). While 299 of 1029 (29.1%) did not receive pharmacologic Rx for diabetes from the VA in the previous year, and many of these may have been new to the system, 355 received Rx in every year from 1999 to 2004. This 5 year cohort as a group was poorly controlled in 1999-2000 (mean HbA1c by same methodology 9.2± 1.8%). These data suggest that a substantial number of our veterans with RxDM are chronically poorly controlled due to submaximal intensity of care and to lifestyle choices.