Drinking alcohol in a harmful way is associated with a large range of health problems. Alcohol use disorder is a term which includes both drinking alcohol in a harmful way and being dependent on alcohol. Diabetes is a common long-term health condition. Good management and treatment can have a big impact on how diabetes affects peoples’ lives and their long-term health. If people with alcohol use disorder receive different treatment to those who do not, this could mean they have worse health outcomes both in terms of their diabetes and also their mental health.
The aim of this project is to investigate how people with diabetes who also have an alcohol use disorder are treated/managed within health care services in England.
For example do they
: • Have worse mental and physical health?
• Receive different treatment and management for their condition?
• Use health services differently than people who do not have an alcohol use disorder?
The findings from the project will be used to identify ways to improve the health of people with diabetes and potentially other long-term health conditions for people living with alcohol use disorders.
Background
Alcohol use disorders are mental health conditions related to alcohol. This umbrella term includes both alcohol dependence and harmful alcohol use. Type 2 diabetes is a common chronic condition where appropriate management and treatment is crucial for health outcomes.
Study hypothesis: People with type 2 diabetes with alcohol use disorder will have worse outcomes for their diabetes and this is mediated through differences in management of their diabetes
Aims and Objectives
The aim of this project is to identify whether people with alcohol use disorder and type 2 diabetes have differential health outcomes and treatment/management to people with type 2 diabetes who do not have alcohol use disorder.
The specific objectives are:
Objective 1) To quantify the incidence of (diabetes-specific) physical health and mental health outcomes in people with type 2 diabetes with alcohol use disorder compared to those without alcohol use disorder using electronic health records
Objective 2) To explore whether there are differences in treatment and management of type 2 diabetes in people with alcohol use disorder compared to people without alcohol use disorder using electronic health records
Methods
A cohort of patients with type 2 diabetes with and without alcohol use disorder will be created using the Clinicial Practice Research Datalink (CPRD) linked with hospital episode statistics (HES) and Office for National statistics mortality data.
Study outcomes will be 1) incidence of common mental disorders (depression and anxiety) and diabetes-specific outcomes (e.g. lower limb amputation) and 2) health service use and markers of diabetes management and treatment (e.g. chronic kidney disease screening).
Statistical analysis will involve appropriate regression modelling and mediation analysis.
Findings from this project will be used to inform clinical guidance and to develop interventions for improving physical and mental health outcomes for people with both conditions.
Objective 1 outcomes:
Outcomes of interest will be Common mental disorders (depression; anxiety) and
Diabetes-specific outcomes (Hypoglycemia; Ketoacidosis; Chronic kidney disease including End Stage Renal Disease; Foot ulcers; Lower limb amputation Diabetic retinopathy; Osteoporosis and bone fractures, CVD morbidity (Myocardial infraction, stroke) and mortality; all-cause mortality)
Objective 2 outcomes:
Outcomes for Objective 2 are health care service use and indicators of type 2 diabetes management within primary care.
Markers of health service use will be consultation rates in primary care; hospital admissions, A&E visits, outpatient appointments for diabetes
Indicators of diabetes management and treatment will be annual diabetes review; HbA1C monitoring; Monitoring of kidney function (serum creatinine); Diabetic eye screening; Foot screening; Cardiovascular disease risk factor screening (serum cholesterol)
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Jennifer Quint - Chief Investigator - Imperial College London
Sarah Cook - Corresponding Applicant - Imperial College London
Ana Luisa Neves - Collaborator - Imperial College London
Arti Maini - Collaborator - Imperial College London
David Osborn - Collaborator - University College London ( UCL )
Ravi Parekh - Collaborator - Imperial College London
Shamini Gnani - Collaborator - Imperial College London
Sonia Saxena - Collaborator - Imperial College London
Thomas Beaney - Collaborator - Imperial College London
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation