Medical complications associated with substance use disorders in patients with type 2 diabetes and hypertension: electronic health record findings

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Abstract

Screening for substance use disorder (SUD) in general medical settings may be particularly important in patients with comorbid health conditions exacerbated by SUD. This study evaluated whether SUD is associated with type 2 diabetes mellitus (T2DM)-complications in patients with co-occurring T2DM and hypertension. Analysis of a limited data set obtained through IBM Watson Health Explorys, a platform integrating data from electronic health records. Matched controls were defined for each of five SUDs: tobacco use disorder (TUD), opioid use disorder (OUD), cocaine use disorder, cannabis use disorder (CUD), and alcohol use disorder (AUD) using Mahalanobis distance within propensity score calipers. All patients were seen in the MetroHealth System (Cleveland, Ohio, USA) and had diagnosis codes for T2DM and hypertension. SUD group participants had a diagnosis of abuse/dependence for the substance of interest. Controls for each SUD group had no diagnosis code related to the SUD of interest and were selected to match the SUD patients on demographics, residential zip code median income, and body mass index. Total sample sizes for each SUD-control comparison ranged from 1,160 for CUD to 22,128 for TUD. Outcome was diagnosis (yes/no) of four T2DM-complications (cerebrovascular accident, diabetic neuropathy, diabetic renal disease, myocardial infarction) and all-cause mortality. Logistic regressions revealed that SUD was significantly associated with greater risk of cerebrovascular accident (TUD-odds ratio (OR)=1.79, OUD-OR=1.94), cocaine use disorder-OR=2.67), diabetic neuropathy (TUD-adjusted odds ratio (aOR)=1.47, cocaine use disorder-aOR=1.35, AUD-aOR=1.27), diabetic renal disease (TUD-aOR=1.25, OUD-OR=1.34), myocardial infarction (TUD-OR=1.96, OUD-OR=2.01, cocaine use disorder-OR=2.68, CUD-OR=2.48, AUD-OR=1.42), and mortality (TUD-OR=1.15, cocaine use disorder-OR=1.61, CUD-aOR=1.49, AUD-OR=1.35). Among patients in Ohio USA with both type 2 diabetes mellitus (T2DM) and hypertension, those with substance use disorders appear to have greater risk for T2DM-complications and all-cause mortality.

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Triggering myocardial infarction by marijuana.

Murray Mittleman, Rebecca Lewis, Malcolm Maclure … (2001)

Marijuana use in the age group prone to coronary artery disease is higher than it was in the past. Smoking marijuana is known to have hemodynamic consequences, including a dose-dependent increase in heart rate, supine hypertension, and postural hypotension; however, whether it can trigger the onset of myocardial infarction is unknown. In the Determinants of Myocardial Infarction Onset Study, we interviewed 3882 patients (1258 women) with acute myocardial infarction an average of 4 days after infarction onset. We used the case-crossover study design to compare the reported use of marijuana in the hour preceding symptoms of myocardial infarction onset to its expected frequency using self-matched control data. Of the 3882 patients, 124 (3.2%) reported smoking marijuana in the prior year, 37 within 24 hours and 9 within 1 hour of myocardial infarction symptoms. Compared with nonusers, marijuana users were more likely to be men (94% versus 67%, P<0.001), current cigarette smokers (68% versus 32%, P<0.001), and obese (43% versus 32%, P=0.008). They were less likely to have a history of angina (12% versus 25%, P<0.001) or hypertension (30% versus 44%, P=0.002). The risk of myocardial infarction onset was elevated 4.8 times over baseline (95% confidence interval, 2.4 to 9.5) in the 60 minutes after marijuana use. The elevated risk rapidly decreased thereafter. Smoking marijuana is a rare trigger of acute myocardial infarction. Understanding the mechanism through which marijuana causes infarction may provide insight into the triggering of myocardial infarction by this and other, more common stressors.

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Relation of Smoking With Total Mortality and Cardiovascular Events Among Patients With Diabetes Mellitus: A Meta-Analysis and Systematic Review.

An Qi Pan, Yeli Wang, Mohammad Talaei … (2015)

The prevalence of smoking in diabetic patients remains high, and reliable quantification of the excess mortality and morbidity risks associated with smoking is important for diabetes management. We performed a systematic review and meta-analysis of prospective cohort studies to evaluate the relation of active smoking with risk of total mortality and cardiovascular events among diabetic patients.

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Mortality among cocaine users: a systematic review of cohort studies.

Louisa Degenhardt, Bianca Calabria, Thomas Kerr … (2011)

To conduct a systematic review of mortality among cohort studies of cocaine users. Three electronic databases were searched (EMBASE, Medline and PsychINFO); other online databases were searched using online libraries and repositories of reports and literature in the drug and alcohol field, with requested contributions from trained librarians and experts. Searches and extraction were undertaken using protocols and cross-checking of decisions by two authors. Additional data were requested from study investigators where studies did not report relevant data. 1911 articles and 2 reports were identified from searches, with data from another four studies located from review articles. Seven cohorts of "problem" or dependent cocaine users reported data that permitted mortality rates to be estimated. Crude mortality rates ranged from 0.53 (95% CI: 0.10-1.58) to 6.16 (95% CI: 5.21-7.11) per 100 PY. Standardised mortality ratios (SMRs) reported in four studies suggested that mortality was four to eight times higher among cocaine users than age and sex peers in the general population. There are limited data on the extent of elevated mortality among problematic or dependent cocaine users and it is unclear how generalisable the results of these studies may be to other populations of problematic cocaine users. Greater attention to both the method of recruitment, and the characteristics of cocaine users, would enhance our understanding of the mortality risks of problematic cocaine use. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.