title: Substance use and mental diagnoses among adults with and without type 2 diabetes: Results from electronic health records data.
abstract: BACKGROUND
  Comorbid diabetes and substance use diagnoses (SUD) represent a hazardous combination, both in terms of healthcare cost and morbidity. To date, there is limited information about the association of SUD and related mental disorders with type 2 diabetes mellitus (T2DM).
  
  
  METHODS
  We examined the associations between T2DM and multiple psychiatric diagnosis categories, with a focus on SUD and related psychiatric comorbidities among adults with T2DM. We analyzed electronic health record (EHR) data on 170,853 unique adults aged ≥18 years from the EHR warehouse of a large academic healthcare system. Logistic regression analyses were conducted to estimate the strength of an association for comorbidities.
  
  
  RESULTS
  Overall, 9% of adults (n=16,243) had T2DM. Blacks, Hispanics, Asians, and Native Americans had greater odds of having T2DM than whites. All 10 psychiatric diagnosis categories were more prevalent among adults with T2DM than among those without T2DM. Prevalent diagnoses among adults with T2MD were mood (21.22%), SUD (17.02%: tobacco 13.25%, alcohol 4.00%, drugs 4.22%), and anxiety diagnoses (13.98%). Among adults with T2DM, SUD was positively associated with mood, anxiety, personality, somatic, and schizophrenia diagnoses.
  
  
  CONCLUSIONS
  We examined a large diverse sample of individuals and found clinical evidence of SUD and psychiatric comorbidities among adults with T2DM. These results highlight the need to identify feasible collaborative care models for adults with T2DM and SUD related psychiatric comorbidities, particularly in primary care settings, that will improve behavioral health and reduce health risk.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA. Electronic address: litzy.wu@duke.edu.
authors.forename: Li-Tzy
authors.initials: LT
authors.lastname: Wu
authors.affiliation: National Institute on Drug Abuse, Bethesda, MD, USA.
authors.forename: Udi E
authors.initials: UE
authors.lastname: Ghitza
authors.affiliation: Division of Endocrinology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Batch
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, NC, USA.
authors.forename: Leoncio Flavio
authors.initials: LF
authors.lastname: Rojas
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Goldstein
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, NC, USA.
authors.forename: Tony
authors.initials: T
authors.lastname: Schibler
authors.affiliation: Duke Translational Research Institute, Duke University, Durham, NC, USA.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Dunham
authors.affiliation: Duke Translational Research Institute, Duke University, Durham, NC, USA.
authors.forename: Shelley
authors.initials: S
authors.lastname: Rusincovitch
authors.affiliation: South Carolina Clinical and Translational Research Institute, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Brady
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000523:psychology*; D017831:Diagnosis, Dual (Psychiatry); D057286:Electronic Health Records; D005006:Ethnicity; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology / Q000523:psychology*; D008875:Middle Aged; D019964:Mood Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D010554:Personality Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D015995:Prevalence; D012559:Schizophrenia / Q000150:complications / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology / Q000523:psychology*; D055815:Young Adult
keywords: Anxiety disorder; Comorbidity; Diabetes mellitus; Electronic health records; Mood disorder; Substance use disorder