Evidence Based Prescription Drug Program, University of Arkansas for Medical Sciences, Little Rock, AR 77205, USA.
Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 77205, USA.
Fam Pract. 2021 Sep 25;38(5):562-568. doi: 10.1093/fampra/cmab008.
Substance use disorder (SUD) is a known barrier to patient-self-management, which can hinder efforts to achieve treatment goals in type 2 diabetes (T2D) when the conditions coexist.
Identify the association between SUD and glycemic control in patients with T2D treated in a primary care setting.
This retrospective cohort study included patients with T2D treated by providers at family medicine clinics at an academic medical center and its affiliated regional sites from January 2014 to October 2019. Study index date was the first A1c recorded when T2D and SUD diagnoses had both been documented in the medical record. Glycemic control, measured by hemoglobin A1c (A1c), was identified at baseline and over a 12-month follow-up period and was compared between SUD and non-SUD patients.
Of 9568 included patients with T2D, 468 (4.9%) had a SUD diagnosis. In 237 SUD and 4334 non-SUD patients with A1c data, mean (SD) baseline A1c was 8.2% (2.5) and 7.9% (2.1), respectively (P = 0.043). A1c reduction was statistically greater in SUD patients than non-SUD patients (-0.31% versus -0.06%, respectively; P = 0.015), although the clinical significance is modest. In a multivariable linear regression analysis, follow-up A1c was lower in the SUD versus non-SUD patients (coefficient -0.184, 95% CI -0.358, -0.010; P = 0.038).
Patients with T2D and SUD had higher baseline A1c but this difference was minimized over a 12-month follow-up period. Additional research is warranted to determine long-term glycemic control and barriers to attaining and maintaining glycemic control in patients with T2D and SUD.
物质使用障碍（SUD）是患者自我管理的已知障碍，当这两种情况同时存在时，可能会阻碍 2 型糖尿病（T2D）患者实现治疗目标的努力。
确定在初级保健环境中治疗的 2 型糖尿病患者中 SUD 与血糖控制之间的关联。
这项回顾性队列研究纳入了 2014 年 1 月至 2019 年 10 月期间在学术医疗中心及其附属地区的家庭医学诊所接受治疗的 2 型糖尿病患者。研究指标日期是在医疗记录中同时记录了 2 型糖尿病和 SUD 诊断后第一次记录 A1c 的日期。通过糖化血红蛋白（A1c）测量血糖控制，在基线和 12 个月的随访期间进行比较，并在 SUD 和非 SUD 患者之间进行比较。
在纳入的 9568 例 2 型糖尿病患者中，有 468 例（4.9%）患有 SUD 诊断。在有 A1c 数据的 237 例 SUD 和 4334 例非 SUD 患者中，平均（SD）基线 A1c 分别为 8.2%（2.5）和 7.9%（2.1）（P=0.043）。与非 SUD 患者相比，SUD 患者的 A1c 降低幅度更大（分别为-0.31%和-0.06%；P=0.015），尽管临床意义不大。在多变量线性回归分析中，SUD 组患者的随访 A1c 低于非 SUD 组（系数-0.184，95%CI-0.358，-0.010；P=0.038）。
患有 2 型糖尿病和 SUD 的患者基线 A1c 较高，但在 12 个月的随访期间，这一差异最小化。需要进一步研究以确定患有 2 型糖尿病和 SUD 的患者的长期血糖控制情况以及实现和维持血糖控制的障碍。
