Substance use disorders and medical comorbidities among high-need, high-risk patients with diabetes.
Abstract
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.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).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.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.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.
Type
Journal articleSubject
HumansDiabetes Complications
Substance-Related Disorders
Treatment Outcome
Prevalence
Hospital Mortality
Risk
Mental Disorders
Comorbidity
Algorithms
Socioeconomic Factors
Adult
Aged
Middle Aged
Delivery of Health Care
Female
Male
Permalink
https://hdl.handle.net/10161/19930Published Version (Please cite this version)
10.1016/j.drugalcdep.2018.01.008Publication Info
Wu, Li-Tzy; Ghitza, Udi E; Zhu, He; Spratt, Susan; Swartz, Marvin; & Mannelli, Paolo (2018). Substance use disorders and medical comorbidities among high-need, high-risk patients
with diabetes. Drug and alcohol dependence, 186. pp. 86-93. 10.1016/j.drugalcdep.2018.01.008. Retrieved from https://hdl.handle.net/10161/19930.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
Paolo Mannelli
Associate Professor of Psychiatry and Behavioral Sciences
Susan Elizabeth Spratt
Associate Professor of Medicine
Marvin Stanley Swartz
Professor of Psychiatry and Behavioral Sciences
My major research interest is in examining the effectiveness of services for severely
mentally ill individuals, including factors that improve or impede good outcomes.
Current research includes: the effectiveness of involuntary outpatient commitment,
psychiatric advance directives, criminal justice outcomes for persons with mental
illnesses, violence and mental illness and antipsychotic medications. I also served
as member of the MacArthur Foundation Research Network on Mandate
Li-Tzy Wu
Professor in Psychiatry and Behavioral Sciences
Education/Training: Pre- and post-doctoral training in mental health service research,
psychiatric epidemiology (NIMH T32), and addiction epidemiology (NIDA T32) from Johns
Hopkins University School of Public Health (Maryland); Fellow of the NIH Summer Institute
on the Design and Conduct of Randomized Clinical Trials.Director: Duke Community Based
Substance Use Disorder Research Program.Research interests: COVID-19, Opioid misuse,
Opioid overdose, Opioid use disorder, Opio
Alphabetical list of authors with Scholars@Duke profiles.

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info