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Alcohol misuse is associated with poor adherence to recommended self-care behaviors, which are critical for diabetes management. This study investigated whether scores on a validated brief alcohol misuse screen are associated with diabetes self-care.
Male outpatients (n=3,930) from seven Veterans Affairs sites returned the Alcohol Use Disorders Ide...
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Citations
... Alcohol consumption can impact health outcomes of pre-existing epilepsy by interfering with anti-epileptic drugs [29]. Moreover, alcohol consumption has been associated with reduced diabetes self-care behaviours as well as lower engagement with diabetes-related care [30,31]. Malignancy stands out as one of the leading causes of premature death among AUD patients [32]. ...
Background
Alcohol-attributable medical disorders are prevalent among individuals with alcohol use disorder (AUD). However, there is a lack of research on prescriptions of pharmacological treatment for AUD in those with comorbid conditions. This study aims to investigate the utilization of pharmacological treatment (acamprosate, disulfiram and naltrexone) in specialist care among patients with AUD and comorbid medical diagnoses.
Methods
This was a descriptive register-based Swedish national cohort study including 132,728 adults diagnosed with AUD ( N = 270,933) between 2007 and 2015. The exposure was alcohol-attributable categories of comorbid medical diagnoses. Odds ratios (OR) were calculated using mixed-effect logistic regression analyses for any filled prescription of acamprosate, disulfiram or oral naltrexone within 12 months post AUD diagnosis.
Results
Individuals with comorbid alcohol-attributable medical diagnoses had lower odds of filling prescriptions for any type of AUD pharmacotherapy compared to those without such comorbidities. Cardiovascular (OR = 0.41 [95% CI: 0.39–0.43]), neurological (OR = 0.52 [95% CI: 0.48–0.56]) and gastrointestinal (OR = 0.57 [95% CI: 0.54–0.60]) diseases were associated with the lowest rates of prescription receipt. The presence of diagnoses which are contraindications to AUD pharmacotherapy did not fully explain the low prescription rate.
Conclusion
There is a substantial underutilization of AUD pharmacotherapy in patients with AUD and comorbid medical disorders in specialist care. Increasing the provision of pharmacotherapy to this group of patients is essential and may prevent morbidity and mortality. There is a need to further understand barriers to medical treatment both from the patient and prescriber perspective.
... Furthermore, based on the score obtained from the AUDIT-C test, we divided our population into five different categories: abstainer (score = 0), low risk (score = 1-3 men; 1-2 female), moderate risk (score = 4 men; 3-4 female); high risk (score = 5-7 men and female) and severe risk (8)(9)(10)(11)(12). The groups were structured based on previous research on the association between alcohol intake and health risks [49][50][51][52]. ...
The period between the beginning and the end of the COVID-19 pandemic emergency generated a general state of stress, affecting both the mental state and physical well-being of the general population. Stress is the body's reaction to events or stimuli perceived as potentially harmful or distressing. Particularly when prolonged over time, it can promote the consumption of different psychotropic substances such as alcohol, and thus the genesis of various pathologies. Therefore, our research aimed to evaluate the differences in alcohol consumption in a cohort of 640 video workers who carried out activities in smart working, subjects particularly exposed to stressful situations due to the stringent rules of protection and prevention implemented during the pandemic. Furthermore , based on the results obtained from the administration of the AUDIT-C, we wanted to analyse the different modes of alcohol consumption (low, moderate, high, severe) to understand whether there is a difference in the amount of alcohol consumed that could predispose individuals to health problems. To this end, we administered the AUDIT-C questionnaire in two periods (T 0 and T 1), coinciding with annual occupational health specialist visits. The results of the present research showed an increase in the number of subjects consuming alcohol (p = 0.0005) and in their AUDIT-C scores (p < 0.0001) over the period considered. A significant decrease in subgroups who drink in a low-risk (p = 0.0049) mode and an increase in those with high (p = 0.00012) and severe risk (p = 0.0002) were also detected. In addition, comparing the male and female populations, it emerged that males have drinking patterns that lead to a higher (p = 0.0067) health risk of experiencing alcohol-related diseases than female drinking patterns. Although this study provides further evidence of the negative impact of the stress generated by the pandemic emergency on alcohol consumption, the influence of many other factors cannot be ruled out. Further research is needed to better understand the relationship between the pandemic and alcohol consumption, including the underlying factors and mechanisms driving changes in drinking behaviour, as well as potential interventions and support strategies to address alcohol-related harm during and after the pandemic.
... Patients with T2D are at elevated risk for numerous other metabolic comorbidities and mental health conditions including substance use disorders (SUD) (3)(4)(5). Misuse of addictive substances may be problematic in patients with T2D because SUD can negatively impact patient health and behaviours that are necessary for glucose control and optimal outcomes including nutrition, adherence to medications and self-management processes (6)(7)(8)(9)(10). ...
Background
Substance use disorder (SUD) is a known barrier to patient-self-management, which can hinder efforts to achieve treatment goals in type 2 diabetes (T2D) when the conditions coexist.
Objective
Identify the association between SUD and glycemic control in patients with T2D treated in a primary care setting.
Methods
This retrospective cohort study included patients with T2D treated by providers at family medicine clinics at an academic medical center and its affiliated regional sites from January 2014 to October 2019. Study index date was the first A1c recorded when T2D and SUD diagnoses had both been documented in the medical record. Glycemic control, measured by hemoglobin A1c (A1c), was identified at baseline and over a 12-month follow-up period and was compared between SUD and non-SUD patients.
Results
Of 9568 included patients with T2D, 468 (4.9%) had a SUD diagnosis. In 237 SUD and 4334 non-SUD patients with A1c data, mean (SD) baseline A1c was 8.2% (2.5) and 7.9% (2.1), respectively (P = 0.043). A1c reduction was statistically greater in SUD patients than non-SUD patients (−0.31% versus −0.06%, respectively; P = 0.015), although the clinical significance is modest. In a multivariable linear regression analysis, follow-up A1c was lower in the SUD versus non-SUD patients (coefficient −0.184, 95% CI −0.358, −0.010; P = 0.038).
Conclusions
Patients with T2D and SUD had higher baseline A1c but this difference was minimized over a 12-month follow-up period. Additional research is warranted to determine long-term glycemic control and barriers to attaining and maintaining glycemic control in patients with T2D and SUD.
... Excessive drinking is associated with increased incidence of numerous medical conditions, including certain cancers, 7-12 cardiovascular disease, [13][14][15] cirrhosis and pancreatitis, [16][17][18][19] and gastrointestinal disorders. 20 In older, predominantly male, white Veterans Health Administration samples, excessive drinking has been found to be associated with increased risk of gastrointestinalrelated hospitalizations, 20,21 postoperative complications, 22 and poorer self-management of chronic diseases, such as diabetes 23 and hypertension. 24 A 2018 meta-analysis 15 found that, even at moderate levels, alcohol use increases all-cause mortality and risk of death from several cardiovascular diseases and reduces life expectancy. ...
Importance
Excessive alcohol consumption is associated with increased incidence of several medical conditions, but few nonveteran, population-based studies have assessed levels of alcohol use across medical conditions.
Objective
To examine associations between medical conditions and alcohol consumption levels in a population-based sample of primary care patients using electronic health record data.
Design, Setting, and Participants
This cross-sectional study used separate multinomial logistic regression models to estimate adjusted associations between 26 medical conditions and alcohol consumption levels in a sample of 2 720 231 adult primary care patients screened for unhealthy drinking between January 1, 2014, and December 31, 2017, then only among those reporting alcohol use. The study was conducted at Kaiser Permanente Northern California, a large, integrated health care delivery system that incorporated alcohol screening into its adult primary care workflow. Data were analyzed from June 29, 2018, to February 7, 2020.
Main Outcomes and Measures
The main outcome was level of alcohol use, classified as no reported use, low-risk use, exceeding daily limits only, exceeding weekly limits only, or exceeding daily and weekly limits, per National Institute on Alcohol Abuse and Alcoholism guidelines. Other measures included sociodemographic, body mass index, smoking, inpatient and emergency department use, and a dichotomous indicator for the presence of 26 medical conditions in the year prior to the alcohol screening identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes.
Results
Among the 2 720 231 included patients, 1 439 361 (52.9%) were female, 1 308 659 (48.1%) were white, and 883 276 (32.5%) were aged 18 to 34 years. Patients with any of the conditions (except injury or poisoning) had lower odds of drinking at low-risk and unhealthy levels relative to no reported use compared with those without the condition. Among 861 427 patients reporting alcohol use, patients with diabetes (odds ratio [OR], 1.11; 95% CI, 1.08-1.15), hypertension (OR, 1.11; 95% CI, 1.09-1.13), chronic obstructive pulmonary disease (COPD; OR, 1.16; 95% CI, 1.10-1.22), or injury or poisoning (OR, 1.06; 95% CI, 1.04-1.07) had higher odds of exceeding daily limits only; those with atrial fibrillation (OR, 1.12; 95% CI, 1.06-1.18), cancer (OR, 1.06; 95% CI, 1.03-1.10), COPD (OR, 1.15; 95% CI, 1.09-1.20), or hypertension (OR, 1.37; 95% CI, 1.34-1.40) had higher odds of exceeding weekly limits only; and those with COPD (OR, 1.15; 95% CI, 1.07-1.23), chronic liver disease (OR, 1.42; 95% CI, 1.32-1.53), or hypertension (OR, 1.48; 95% CI, 1.44-1.52) had higher odds of exceeding both daily and weekly limits.
Conclusions and Relevance
Findings suggest that patients with certain medical conditions are more likely to have elevated levels of alcohol use. Health systems and clinicians may want to consider approaches to help targeted patient subgroups limit unhealthy alcohol use and reduce health risks.
... 38,50,51 Although most evident for heavy alcohol consumption and intravenous drug use, even low levels of alcohol intake are associated with reduced diabetes self-care behaviours, reduced attendance for diabetes complications screening, and lower engagement with other aspects of diabetes-related care. 36,52 People with type 2 diabetes who have been prescribed opioids also participate Review less in screening programmes for diabetes-related complications and have higher HbA 1c concen trations when compared with those not prescribed opioids. 53 ...
As the prevalence of type 1 and type 2 diabetes increases and population-level patterns of alcohol and illicit drug use evolve, clinicians will continue to encounter people with diabetes whose substance use is affecting health outcomes. Substance use contributes substantially to the population-level prevalence of cardiovascular events, cerebrovascular events, cancers, mental health conditions, road trauma, and domestic violence. Alcohol and drug use also have a measurable effect on diabetes incidence and the development of both acute and chronic diabetes-related complications. In this Review, we examine the effect of alcohol and illicit drug use on people with type 1 or type 2 diabetes. We describe evidence for substance use as a risk factor for new-onset diabetes, prevalence of use in people with diabetes, evidence linking substance use with diabetes-related health outcomes, and evidence on the management of these co-occurring conditions.
... 26 Given the inconsistencies in clinical practice around the recommendations for alcohol use in blood sugar control, this investigation aims to clarify the relationship between alcohol and HbA1c by controlling for known confounders. Alcohol has been associated with poorer T2DM self-care, 27 yet it remains unclear if alcohol is metabolically helpful for those with T2DM. ...
With the rising prevalence of type 2 diabetes mellitus (T2DM), there is debate regarding biological and psychosocial risk factors. While it is well established that alcohol lowers glycohemoglobin (HbA1c) levels, it is less clear whether alcohol consumption is protective of T2DM. It is also unclear how gender and ethnicity influence the utility of HbA1c screening as a tool for T2DM diagnosis, particularly in the context of alcohol use. This cross-sectional study utilized the National Health and Nutrition Examination Survey 2013-2014 dataset and was restricted to adults 20 years and older, nonpregnant, and not on antihypertensive medication (n = 4299) to evaluate the relationship between alcohol use and HbA1c. A multilinear regression model controlled for gender, ethnicity, education level, body mass index, and age. After controlling for covariates, both moderate (β = -0.073; p = 0.033) and heavy drinking (β = -0.167; p < 0.001) are associated with reduced HbA1c levels. Additionally, female gender is a significant negative predictor of HbA1c (β = -0.052; p = 0.024) and all ethnic groups have higher levels of HbA1c compared with non-Hispanic whites. Plausible biological mechanisms are discussed. The clinical utility of HbA1c as a screening tool for T2DM without considering alcohol use, gender, and ethnicity may lead to diagnostic errors. Individualized approaches and focused efforts toward health equity are needed to address rising rates of T2DM.
... Each patient's first documented AUDIT-C score after enrollment in VACS was used to categorize patients into five levels of alcohol use, reflecting non-drinking (AUDIT-C score 0 points), low-(AUDIT-C 1-3 men/1-2 women), medium-(AUDIT-C 4-5 men/3-5 women), high-(AUDIT-C 6-7), and very high-(AUDIT-C 8-12) level drinking. These categories were selected based on previous research demonstrating increased consumption, severity, and probability of alcohol dependence associated with increasing AUDIT-C scores [36,41] and previous studies that have identified clinically meaningful differences in risk of medical and surgical outcomes across similar AUDIT-C categories [42][43][44][45][46][47][48][49][50][51][52][53][54][55]. ...
We evaluated associations between levels of alcohol use and HIV care continuum components using national Veterans Aging Cohort Study data for all patients with HIV and AUDIT-C screening (2/1/2008-9/30/2014). Poisson regression models evaluated associations between alcohol use levels (non-drinking, low-, medium-, high-, and very high-level drinking) and: (1) engagement with care (documented CD4 cells/µl or viral load copies/ml labs), (2) ART treatment (≥ 1 prescription), and (3) viral suppression (HIV RNA < 500 copies/ml) within one year. Among 33,224 patients, alcohol use level was inversely associated with all care continuum outcomes (all p < 0.001). Adjusted prevalence of care engagement ranged from 77.8% (95% CI 77.1-78.4%) for non-drinking to 69.1% (66.6-71.6%) for high-level drinking. The corresponding range for ART treatment was 74.0% (73.3-74.7%) to 60.1% (57.3-62.9%) and for viral suppression was 57.3% (56.5-58.1%) to 38.3% (35.6-41.1%). Greater alcohol use is associated with suboptimal HIV treatment across the HIV care continuum.
... Major risk factors for T2DM in people with AUDs include the high risk for acute pancreatitis ( Das et al., 2013), unhealthy lifestyle behaviors such as lack of sufficient physical activity ( Smothers and Bertolucci, 2001), co-morbid substance abuse ( McKee et al., 2007) in particular smoking ( Goodwin et al., 2013) and an impaired cardiorespiratory fitness ( Herbsleb et al., 2013). Once developed, patients with AUDs have a severely impaired diabetes self-management and worse health outcomes ( Thomas et al., 2012). Prevention and treatment of T2DM therefore demands careful consideration in clinical practice, and particularly in those with an increased risk for cardiovascular diseases and associated premature mortality ( Alberti and Zimmet, 1998). ...
Type 2 Diabetes Mellitus (T2DM) is highly predictive of cardiovascular diseases and is associated with worse quality of life and increased healthcare utilisation. The current meta-analysis aimed to (i) describe the pooled prevalence of T2DM in people with alcohol use disorders (AUDs), (ii) investigate the impact of demographic, clinical and treatment factors, and (iii) compare T2DM prevalences in AUDs versus the general population. The trim and fill adjusted pooled T2DM prevalence among 3,998 people with AUDs (age range 34.8 to 51.1 years; 76.6% male) (N studies=7) was 12.4% (95%CI=11.8%-13.9%). Higher T2DM prevalences were observed in studies with a higher mean age and a higher percentage of male participants, and in studies with self- or physician reported T2DM assessment. A trend for higher T2DM prevalences was found in inpatient settings, in studies assessing T2DM with the gold-standard oral glucose tolerance test compared with fasting glucose only, and with studies including patients with a higher percentage of physical co-morbidity. Although healthy control data are lacking, the pooled prevalence is similar to that observed in people with severe mental illness who are considered a high-risk group. Routine screening and multidisciplinary management of T2DM in people with AUDs is needed.
... 12 Unhealthy alcohol use is a particular concern for older adults, many of whom have chronic conditions that could be worsened due to drinking 13 and could be at risk for medication interactions. 14 Unhealthy alcohol use is associated with poorer medication adherence 15,16 and self-care for chronic conditions, 17,18 hospital acquired infections, 19 and increased risk for injuries. 20,21 Alcohol consumption after hospital discharge could put patients at risk for readmission due to injuries or trauma resulting from acute intoxication 22 or interactions with medications. ...
Hospital readmissions and emergency department (ED) visits within 30 days of discharge are costly. Heavy alcohol use could predict increased risk for post-discharge acute care. This study assessed 30-day acute care utilization and expenditures for different categories of alcohol use. Veterans Affairs (VA) patients age ≥65 years with past-year alcohol screening, hospitalized for a medical condition, were included. VA and Medicare health care utilization data were used. Two-part models adjusted for patient demographics. Among 416,050 hospitalized patients, 25% had 30-day acute care use. Nondrinking patients (n = 267,746) had increased probability of acute care use, mean utilization days, and expenditures (difference of $345; 95% CI $268-$423), relative to low-risk drinkers (n = 105,023). High-risk drinking patients (n = 5,300) had increased probability of acute care use and mean utilization days, but not expenditures. Although these patients did not have greater acute care expenditures than low-risk drinking patients, they may nevertheless be vulnerable to poor post-discharge outcomes.
... 11 Alcohol misuse is likely to worsen hypertension, 12 is associated with poorer adherence to antihypertensive medications, 13 and has been associated with poorer diabetes self-care behaviors. 14,15 While prior studies have assessed the prevalence of cardiovascular health behaviors among adults with hypertension, 16,17 no previous study to our knowledge has described whether adherence to cardiovascular health behaviors differs by level of alcohol use. Because a doseresponse association between levels of alcohol use and cardiovascular health behaviors would support a causal association, understanding whether such an association exists may influence clinician provision of brief alcohol interventions to hypertensive patients. ...
... 19 Increasing AUDIT-C scores reflect increased alcohol consumption, adverse consequences of drinking, and likelihood of alcohol use disorders. 20,21 Patients were divided a priori into five groups based on AUDIT-C scores (0-12 points) used in prior research: 15 no past year alcohol use (0 points), low-level alcohol use (1)(2)(3), and mild (4-5), moderate (6-7), and severe (8-12) misuse. 13,22 Cardiovascular Health Behaviors-Four primary outcomes of cardiovascular health behaviors were derived based on patient report of avoiding salt, exercising, controlling weight, and not smoking. ...
... The proportion of patients who reported avoiding salt, controlling weight, and not smoking were 12% to 20% lower in those with the highest alcohol use compared with those who reported no alcohol use. Although increasing alcohol use is associated with decreased self-care in patients with diabetes, 14,15 and decreased medication adherence in patients with hypertension, 13 no previous study to our knowledge has described the association between increasing alcohol use and cardiovascular health behaviors in patients with hypertension. ...
Background:
Alcohol use is associated with health behaviors that impact cardiovascular outcomes in patients with hypertension, including avoiding salt, exercising, weight management, and not smoking. This study examined associations between varying levels of alcohol use and self-reported cardiovascular health behaviors among hypertensive Veterans Affairs (VA) outpatients.
Methods:
Male outpatients with self-reported hypertension from 7 VA sites who returned mailed questionnaires (N = 11,927) were divided into 5 levels of alcohol use: nondrinking, low-level use, and mild, moderate, and severe alcohol misuse based on AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) scores (0, 1-3, 4-5, 6-7, and 8-12, respectively). For each category, adjusted logistic regression models estimated the prevalence of patients who self-reported avoiding salt, exercising, controlling weight, or not smoking, and the composite of all four.
Results:
Increasing level of alcohol use was associated with decreasing prevalence of avoiding salt, controlling weight, not smoking, and the combination of all 4 behaviors (P values all <.001). A linear trend was not observed for exercise (P =.83), which was most common among patients with mild alcohol misuse (P =.01 relative to nondrinking).
Conclusions:
Alcohol consumption is inversely associated with adherence to cardiovascular self-care behaviors among hypertensive VA outpatients. Clinicians should be especially aware of alcohol use level among hypertensive patients.
