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

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.

To improve care delivery, this study compared patients with diabetes and co-occurring SUD to those with diabetes and no SUD.

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.

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.

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.

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.

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.