同时存在的物质使用障碍与糖尿病护理质量、并发症及住院情况的关联。
Associations of Co-Occurring Substance Use Disorder With Diabetes Care Quality, Complications, and Hospitalizations.
作者信息
Knox Margae J, Hodgkin Dominic, Slama Natalie E, Sterling Stacy A, Gilliam Lisa K, Asyyed Asma, Iturralde Esti
机构信息
Division of Research, Kaiser Permanente Northern California Pleasanton, CA.
The Heller School for Social Policy and Management, Brandeis University, Waltham, MA.
出版信息
Med Care. 2025 Jun;63(6):443-448. doi: 10.1097/MLR.0000000000002138.
BACKGROUND
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.
OBJECTIVE
To improve care delivery, this study compared patients with diabetes and co-occurring SUD to those with diabetes and no SUD.
POPULATION
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.
RESEARCH DESIGN
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.
MEASURES
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.
RESULTS
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.
CONCLUSIONS
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.
背景
物质使用障碍（SUD）是糖尿病并发症和住院治疗的一个风险因素，不过，在接受物质使用治疗的糖尿病患者中，尚未对糖尿病护理质量和健康结局的完整连续情况进行研究。
目的
为改善护理服务，本研究将患有糖尿病且同时患有物质使用障碍的患者与患有糖尿病但无物质使用障碍的患者进行了比较。
研究对象
纳入了2016年至2021年期间在一个大型综合医疗系统中进行过物质使用障碍专科治疗就诊的4325例糖尿病患者，以及255,652例无物质使用障碍诊断的糖尿病患者。
研究设计
使用电子健康记录数据进行回顾性队列研究。修正泊松回归模型估计了同时存在物质使用障碍与每种结局之间的关系，并对社会人口学和临床因素进行了调整。
测量指标
护理质量指标包括糖化血红蛋白（HbA1c）、血压、视网膜和胆固醇筛查、HbA1c < 8%、血压 < 140/90 mmHg以及低密度脂蛋白胆固醇（LDL - 胆固醇）< 100 mg/dL。糖尿病并发症包括心血管疾病、脑血管疾病、视网膜病变和下肢疾病。住院类型包括糖尿病相关疾病和其他疾病，例如慢性肝病和精神疾病。
结果
与无物质使用障碍的患者相比，同时患有物质使用障碍的患者男性更多、更年轻、非西班牙裔白人，且患有情绪障碍。同时存在物质使用障碍与更多的HbA1c筛查以及更低的HbA1c <8患病率相关，但也与几乎所有并发症类型以及除一种住院类型外的所有住院类型的风险升高有关，尤其是慢性肝病和慢性疼痛相关住院。
结论
尽管糖尿病护理质量相当或更好，但同时患有物质使用障碍的患者并发症和住院风险仍然较高。生物心理社会机制和基于系统的机制可能都导致了这些风险升高。跨部门的护理协调可能有助于满足多方面的健康需求。
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