How Do Pre-existing Health Factors Impact Newly Diagnosed Diabetes?

Patients with mental health and substance use disorders who receive a new diabetes diagnosis are more likely to have additional medical complications compared to patients without those disorders. In a new study, researchers reporting in JAMA Network Open sought to determine how previous mental health and substance use disorders and primary care utilization prior to a diabetes diagnosis impacted long-term severity of diabetes complications. Data were gathered from the U.S. Department of Veterans Affairs health care systems. Eligible patients were diagnosed with diabetes in 2008 and aged between 18 and 85 years. Patients were stratified into the following groups: mental health disorder only, substance use disorder only, mental health and substance use disorders, or no mental health or substance use disorder diagnoses; they were also analyzed based on the amount of primary care utilization prior to their diabetes diagnosis. The primary outcome was nine-year trajectory of Diabetes Complication Severity Index (DCSI) score. Final analysis included 122,992 patients (mean age, 62.3 years; 96.6% were male) who received a new diabetes diagnosis, of whom 28,633 (23.3%) had a preexisting mental health or substance use disorder diagnosis. From the time of diabetes diagnosis to seven years later, mean estimated DCSI scores increased from 0.84 to 1.42. When controlling for sociodemographic characteristics and medical comorbidities, patients with substance use disorders only or substance use and mental health disorders had lower DCSI scores at the time of onset diabetes compared to patients without either disorder. Patients with mental health or substance use disorders were more likely to have prior primary care visits compared to those without either disorder (more than 90% vs. 58%); patients with a history of primary care visits had lower baseline DCSI scores. During the seven-year period from the time of diabetes diagnosis, patients with mental health or substance use disorders had lower overall mean DCSI scores, but their scores also increased at a faster rate, compared to patients without either disorder.

Source: Schmidt EM, Barnes J, Chen C, et al. JAMA Netw Open. 2019;doi: 10.1001/jamanetworkopen.2019.12060