JAMA Network Open | 2019
Patient and Health Care Factors Associated With Long-term Diabetes Complications Among Adults With and Without Mental Health and Substance Use Disorders
Abstract
Key Points Question Among patients with newly diagnosed diabetes, are preexisting mental health (MH) or substance use (SU) disorders and primary care utilization before a new diabetes diagnosis associated with the long-term severity of diabetes complications? Findings In this cohort study of 122\u2009992 patients in the US Department of Veterans Affairs health system, more than 90% of patients with MH or SU disorders had primary care visits before diabetes was newly diagnosed, compared with approximately 58% of patients without MH or SU disorders. Patients with MH or SU disorders experienced significantly lower severity of diabetes complications for 7 years thereafter, compared with patients without preexisting MH or SU disorders, even after controlling for sociodemographic characteristics and medical comorbidities. Meaning Among patients with MH or SU disorders, receiving more medical and mental health care from an integrated health care system before the onset of diabetes is associated with modest, albeit impermanent, health benefits after the onset of diabetes.