Diabetes complications in people with alcohol use disorder and type 2 diabetes

People living with alcohol use disorder (AUD) who develop type 2 diabetes (T2DM) may be at higher risk of diabetes complications.

Our aim was to compare diabetes monitoring and incidence of diabetes complications between people with and without AUD prior to T2DM diagnosis attending primary care in England.

We used the Clinical Practice Research Datalink Aurum linked with Hospital Episode Statistics and Office for National Statistics mortality data. The target population was people with incident T2DM diagnosed between 2004 and 2019.

We defined AUD from codes indicating i) clinical diagnosis; ii) alcohol withdrawal; or iii) chronic alcohol-related harm. Outcomes were end-stage renal disease (ESRD), lower limb amputation, myocardial infarction (MI), stroke, cardiovascular disease (CVD) mortality, and all-cause mortality. We compared yearly HbA1c, creatinine, and cholesterol monitoring activities for the first 5 years post T2DM diagnosis.

The study population was 543 509 people, of whom 15 237 (2.8%) had a code for AUD. Adjusting for measured confounders, people with AUD had higher rates of ESRD ( incidence rate ratio [IRR] 1.95, 95% confidence intervals [CI] = 1.71 to 2.23), lower limb amputation (IRR 1.78, 95% CI = 1.50 to 2.21), stroke (IRR 1.36, 95% CI = 1.25 to 1.47), CVD mortality (IRR 1.74, 95% CI = 1.63 to 1.86), and all-cause mortality (IRR 2.10, 95% CI = 2.04 to 2.17) but not MI (IRR 0.91, 95% CI = 0.82 to 1.00) compared with people without AUD. Laboratory diabetes monitoring was high in people with (83.5-91.1%) and without (83.7-92.4%) AUD.

People with AUD had nearly double the rates of most of the diabetes complications investigated compared with people without AUD.