Associations of Co-Occurring Substance Use Disorder With Diabetes Care Quality, Complications, and Hospitalizations

Abstract

Background: Substance use disorder (SUD) is a risk factor for diabetes complications and hospitalizations, though a full continuum of diabetes care quality and health outcomes has not been examined among patients with diabetes accessing substance use treatment. Objective: To improve care delivery, this study compared patients with diabetes and co-occurring SUD to those with diabetes and no SUD. Population: In all, 4325 patients with diabetes and a SUD specialty treatment visit versus 255,652 patients with diabetes and no SUD diagnosis in a large, integrated delivery system from 2016 to 2021 were included. Research Design: Retrospective cohort study using electronic health record data. Modified Poisson regression models estimated relationships for co-occurring SUD and each outcome, adjusting for sociodemographic and clinical factors. Measures: Care quality measures included HbA1c, blood pressure, retinal and cholesterol screening, HbA1c < 8%, blood pressure < 140/90 mm Hg, and LDL-cholesterol < 100 mg/dL. Diabetes complications included cardiovascular, cerebrovascular, retinopathy, and lower limb conditions. Hospitalization types included diabetes-related and other conditions, for example, chronic liver disease, and psychiatric. Results: Patients with co-occurring SUD, compared with those without SUD, were more often male, younger, non-Hispanic White, and had a mood disorder. Co-occurring SUD was associated with more HbA1c screening and higher prevalence of HbA1c < 8, yet also with elevated risks for nearly all complication types, and all but one hospitalization type, especially chronic liver disease and chronic pain-related hospitalization. Conclusions: Despite comparable or better diabetes care quality, elevated risk of complications and hospitalization persisted among patients with co-occurring SUD. Both biopsychosocial and system-based mechanisms likely contribute to these elevated risks. Silo-bridging care coordination may help address multifaceted health needs.