Type 2 Diabetes Health Care Outcomes for Patients with Alcohol Use Disorder Starting Addiction Treatment.

BACKGROUND

Alcohol use disorder (AUD) is common and may complicate type 2 diabetes (T2DM) management. Little research has examined diabetes outcomes for people with T2DM and AUD, including during the window when patients start specialty addiction treatment.

OBJECTIVE

To examine diabetes-related health monitoring, clinical outcomes, and acute health care use among patients with T2DM and AUD newly accessing specialty addiction treatment.

DESIGN

This retrospective cohort study included electronic health record data from a large, integrated health care delivery system.

PATIENTS: Adults with T2DM and an index outpatient health care visit during 2016-2021 were included. Patients whose index visit was an initial AUD-related visit in specialty addiction treatment were in the AUD group. The comparison group had no AUD or addiction medicine visits.

MAIN MEASURES: Outcomes were diabetes-related health monitoring, achievement of treatment targets, complications, and acute health care use during the 12 months post-index visit.

KEY

RESULTS

The study included 222,334 adults with T2DM, 1,998 with AUD. Relative to the comparison group, participants with AUD had elevated risk for hypoglycemia (adjusted risk ratio [aRR] = 2.14; 95% confidence interval [CI] = 1.49, 3.08), cardiovascular complications (aRR = 1.43; 95% CI = 1.34, 1.53), and neuropathy (aRR = 1.26; 95% CI = 1.14, 1.41), and were less likely to be non-smokers (aRR = 0.88; 95% CI = 0.86, 0.90), after adjusting for confounding factors. In adjusted models, the AUD versus comparison group had similar or higher rates of diabetes monitoring (e.g., any glycemic test, aRR = 1.19; 95% CI = 1.17, 1.22) and metabolic control (e.g., hemoglobin A1c < 8.0%, aRR = 1.14; 95% CI = 1.11, 1.18).

CONCLUSIONS

Patients with co-occurring T2DM and AUD in an integrated health care delivery system are vulnerable to diabetes complications that could be addressed during the early phase of specialty addiction treatment.