Medical complications associated with substance use disorders in patients with type 2 diabetes and hypertension: Electronic health record findings.

The following files have been made publicly available by the authors:

• Overview of SAS Matching Programs Developed by the NIDA CTN Ohio Valley Node (.pdf)
• Greedy matching data file (.zip file containing .sas file)
• Optimal matching data file (.zip file containing .sas file)

Substance use disorder (SUD) screening has been recommended for general medical healthcare settings, but remains underutilized. An alternative to universal SUD screening would be screening in patients with medical conditions significantly exacerbated by SUD. This value-based approach may be particularly useful for patients with multiple chronic health conditions, who account for the majority of healthcare spending and who interface frequently with the healthcare system, affording greater opportunity for screening and treatment coordination.

This study evaluated whether SUD is associated with type 2 diabetes mellitus (T2DM) complications in patients with co-occurring T2DM and hypertension, a patient group selected due to the prevalence, cost, and morbidity and mortality associated with this combination of health issues.

This analysis used a limited data set obtained through IBM Watson Health Explorys, a platform integrating data from electronic health records. Matched controls were defined for each of five SUDs: tobacco use disorder (TUD), opioid use disorder (OUD), cocaine use disorder, cannabis use disorder (DUC) and alcohol use disorder (AUD) using Mahalanobis distance within propensity score calipers. All patients were seen in the Metro Health System (Cleveland, OH, USA), and had diagnosis codes for T2DM and hypertension.

Outcome was diagnosis (yes/no) of four T2DM complications (cerebrovascular accident, diabetic neuropathy, diabetic renal disease, myocardial infarction) and all-cause mortality. Logistic regressions revealed that SUD was significantly associated with greater risk of:

• cerebrovascular accident (TUD odds ratio (OR) = 1.79, OUD-OR = 1.94, cocaine use disorder OR = 2.67),
• diabetic neuropathy (TUD-adjusted OR (aOR) = 1.47, cocaine use
  disorder-aOR = 1.35, AUD-aOR = 1.27],
• diabetic renal disease (TUD-aOR = 1.25, OUD-OR = 1.34),
• myocardial infarction, (TUD-OR = 1.96, OUD-OR = 2.01,
• cocaine use disorder (TUD-aOR = 2.68, CUD-OR = 2.48, AUD-OR = 1.42), and
• mortality (TUD-OR = 1.15, cocaine use disorder-OR = 1.61, CUD-OR = 1.49, AUD-OR = 1.35).

Conclusions: Among patients in Ohio with both type 2 diabetes mellitus (T2DM) and hypertension, those with substance use disorders appear to have greater risk for T2DM complications and all-cause mortality. Future research to replicate this finding and to delineate the potential mechanisms by which SUD may impact T2DM-related outcomes seems warranted.