Association Between Primary Care Utilization for Preexisting Conditions and Outcomes in Newly Diagnosed Diabetes

Diabetes patients with mental health or substance use disorders are known to have a greater risk of medical complications. In this study, researchers examined whether seeking primary care for these conditions prior to receiving a diabetes diagnosis affected the long-term severity of diabetes complications. Medical record data from the U.S. Department of Veterans Affairs health care systems were evaluated. Patients who received a new diabetes diagnosis in 2008 and were aged 18 to 85 years at the time were eligible for inclusion. Patients were stratified into the following groups: mental health disorder only, substance use disorder only, mental health and substance use disorder, or no mental health or substance use disorder diagnoses. They were further categorized based on the amount of primary care they used prior to their diabetes diagnosis. Final analysis included 122,992 newly diagnosed diabetes patients (mean age, 62.3 years; 96.6% were male). Of the total cohort, 23.3% had preexisting mental health or substance use disorder diagnoses. During the seven-year period from the onset of diabetes, the mean estimated Diabetes Complication Severity Index (DCSI) scores increased from 0.84 to 1.42. When controlling for sociodemographic characteristics and medical comorbidities, patients with substance use disorders only or both mental health and substance use disorders had lower DCSI scores at the time of their diabetes diagnosis compared to patients without preexisting mental health or substance use disorder diagnoses; this correlation was not observed in patients with mental health disorders only. Patients with either existing disorders were significantly more likely to have previous primary care visits compared to those without preexisting mental health or substance use disorders. Patients with a history of primary care utilization, compared to those without, had lower baseline DCSI scores.