December 19, 2018
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Substance use higher among adults with type 1 diabetes vs. general population

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Use of substances such as alcohol, opioids and sedative medications may be higher among adults with type 1 diabetes compared with the overall U.S. population, according to findings published in The Diabetes Educator.

“A diagnosis of type 1 diabetes most often occurs in late childhood or adolescence, the typical onset for substance use initiation,” Nicole Foster, MS, a biostatistician at the Jaeb Center for Health Research in Tampa, Florida, and colleagues wrote. “Data in youth suggest that a diagnosis of type 1 diabetes may delay onset of substance use in early adolescence, but by the end of high school, those with type 1 diabetes have rates of substance use as high as their non-type 1 diabetes counterparts.”

Foster and colleagues identified 4,311 adults from the TID Exchange with type 1 diabetes for at least 1 year and invited them by email to complete a survey related to substance use based on the Alcohol, Smoking and Substance Involvement Screening Test and the Alcohol Use Disordered Identification Test. A total of 936 individuals elected to participate (mean age, 39 years; 61% women; median age at diagnosis, 13 years; range, 8 to 21 years). The researchers obtained demographic and clinical data from TID Exchange records.

Among the cohort, 18% reported using nicotine in the previous year, with 5% reporting that they smoked daily. In contrast, 55% reported that they had never used nicotine, which the researchers noted was “toward the high range of never smokers obtained from general population surveys.”

Alcohol use in the previous year was reported by 79% of the cohort, which is slightly higher than among the general population, according to the researchers.

Of those who reported drinking alcohol, 10% were categorized as “problematic drinkers,” which was defined by a score of eight or more on the Alcohol Use Disordered Identification Test. Binge drinking, defined as drinking five or more drinks per day for men and four or more for women, was reported by 19% of the participants.

“Alcohol use can affect glycemic control by impairing glucose homeostasis and self-management behaviors,” the researchers wrote. “So, binge drinking, which is occurring in about a quarter of adults with type 1 diabetes, holds potential to have adverse consequences on diabetes management and outcomes.”

As for other substance use, which included marijuana, opioids, sedatives and stimulants, 24% reported use in the previous year. According to the researchers, this was roughly 6% more than the general population. Marijuana was the most commonly used substance (17.9%) with opioids (7%), sedatives (5%) and stimulants (4%) following.

“These data underscore the need to inquire about regular as well as intermittent use of nicotine and psychoactive substances in patients with type 1 diabetes,” the researchers wrote. “Although heavy and problem use of any substance is likely to compound the adverse effects of type 1 diabetes, delineation of the impact of moderate and occasional use of these substances on type 1 diabetes management and outcomes is needed to inform clinical recommendations regarding their use.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.