• Esti Iturralde, Natalie E Slama, Neha Balapal, Margae J Knox, Lisa K Gilliam, Derek D Satre, Stacy A Sterling, and Asma Asyyed.
• Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Drive, Pleasanton, CA, 94588, USA. estibaliz.m.iturralde@kp.org.
• J Gen Intern Med. 2024 Dec 3.

BackgroundAlcohol use disorder (AUD) is common and may complicate type 2 diabetes (T2DM) management. Little research has examined diabetes outcomes for people with T2DM and AUD, including during the window when patients start specialty addiction treatment.ObjectiveTo examine diabetes-related health monitoring, clinical outcomes, and acute health care use among patients with T2DM and AUD newly accessing specialty addiction treatment.DesignThis retrospective cohort study included electronic health record data from a large, integrated health care delivery system.PatientsAdults with T2DM and an index outpatient health care visit during 2016-2021 were included. Patients whose index visit was an initial AUD-related visit in specialty addiction treatment were in the AUD group. The comparison group had no AUD or addiction medicine visits.Main MeasuresOutcomes were diabetes-related health monitoring, achievement of treatment targets, complications, and acute health care use during the 12 months post-index visit.Key ResultsThe study included 222,334 adults with T2DM, 1,998 with AUD. Relative to the comparison group, participants with AUD had elevated risk for hypoglycemia (adjusted risk ratio [aRR] = 2.14; 95% confidence interval [CI] = 1.49, 3.08), cardiovascular complications (aRR = 1.43; 95% CI = 1.34, 1.53), and neuropathy (aRR = 1.26; 95% CI = 1.14, 1.41), and were less likely to be non-smokers (aRR = 0.88; 95% CI = 0.86, 0.90), after adjusting for confounding factors. In adjusted models, the AUD versus comparison group had similar or higher rates of diabetes monitoring (e.g., any glycemic test, aRR = 1.19; 95% CI = 1.17, 1.22) and metabolic control (e.g., hemoglobin A1c < 8.0%, aRR = 1.14; 95% CI = 1.11, 1.18).ConclusionsPatients with co-occurring T2DM and AUD in an integrated health care delivery system are vulnerable to diabetes complications that could be addressed during the early phase of specialty addiction treatment.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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