Substance use disorders and medical comorbidities among high-need, high-risk patients with diabetes.

Journal Article (Journal Article)

BACKGROUND: The majority of the U.S. healthcare resources are utilized by a small population characterized as high-risk, high-need persons with complex care needs (e.g., adults with multiple chronic conditions). Substance use disorders (SUDs) and mental health disorders (MHDs) are a driver of poor health and additional healthcare costs, but they are understudied among high-need patients. OBJECTIVE: We examine the prevalence and correlates of SUDs and MHDs among adults with high-risk diabetes, who are patients at the top 10% risk score for developing poor outcomes (hospital admission or death). METHODS: A risk algorithm developed from Duke University Health System electronic health records (EHRs) data was used to identify patients with high-risk diabetes for targeting home-based primary care. The EHR data of the 263 patients with high-risk diabetes were analyzed to understand patterns of SUDs and MHDs to inform care-coordinating efforts. RESULTS: Both SUDs (any SUD 48.3%, alcohol 12.5%, tobacco 38.8%, drug 23.2%) and MHDs (any MHD 74.9%, mood 53.2%, sleep 37.3%, anxiety 32.7%, schizophrenia/psychotics/delusional 14.8%, dementia/delirium/amnestic/cognitive 14.4%, adjustment 9.1%) were prevalent. Overall, 81.7% of the sample had SUD or MHD. Elevated odds of SUD were noted among men (tobacco, alcohol) and those who were never-married (alcohol, cannabis). African-American race (vs. other race/ethnicity) was associated with lower odds of anxiety disorders. CONCLUSION: While data are limited to one large academic health system, they provide clinical evidence revealing that 82% of patients with high-risk diabetes had SUD and/or MHD recorded in their EHRs, highlighting a need for developing service models to optimize high-risk care.

Full Text

Duke Authors

Cited Authors

  • Wu, L-T; Ghitza, UE; Zhu, H; Spratt, S; Swartz, M; Mannelli, P

Published Date

  • May 1, 2018

Published In

Volume / Issue

  • 186 /

Start / End Page

  • 86 - 93

PubMed ID

  • 29554592

Pubmed Central ID

  • PMC5959045

Electronic International Standard Serial Number (EISSN)

  • 1879-0046

Digital Object Identifier (DOI)

  • 10.1016/j.drugalcdep.2018.01.008


  • eng

Conference Location

  • Ireland