Abstract
Importance: Comorbid substance use disorder (SUD) is associated with poor clinical outcomes among people with diabetes, but limited research has examined targeted intervention strategies for patients with both conditions. Methods: We conducted a rapid literature review using PubMed to examine past diabetes screening and intervention studies for patients with SUD (study 1) . To investigate potential intervention targets, we compared clinical factors and health care utilization among patients with SUD and diabetes comorbidity (comorbid group) to patients with one but not both of these conditions (SUD-only or diabetes-only groups; study 2) . Study 2 included electronic health record (EHR) data from 2,734 adults with SUD (of whom 8% had comorbid diabetes) who were treated for SUD in an integrated health care system in 20 (comorbid group N = 217; SUD-only group N = 2,517) . We also evaluated previously published data from the same health system for patients with diabetes and low rates of SUD (diabetes-only group, N = 264,844) . Results: In study 1, there was limited literature found on comorbid SUD and diabetes. No studies were found on interventions in the behavioral health or SUD treatment setting. In study 2, comorbid diabetes relative to SUD-only was associated with higher rates of emergency department (ED) and hospital use (aOR = 1.85, 1.56; p values < 0.05) , after adjusting for demographic and SUD factors. The comorbid group had higher rates of diagnosed cardiovascular disease, hypertension, and dyslipidemia (29%, 69.6%, 56.7%, versus 6.6%, 22.6%, 17% in SUD-only) . Relative to the diabetes-only group, the comorbid group had similar rates of HbA1c > 9.0. Conclusions and Relevance: Patients with diabetes who are receiving SUD treatment are vulnerable to poor cardiovascular health and frequent visits to the ED and hospital. Though understudied, models that integrate diabetes care into SUD treatment could be helpful. Disclosure E. Iturralde: None.
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