AIMS Substance use is common among adults with diabetes yet remains poorly characterized in terms of co-occurring patterns. This study sought to identify distinct substance use profiles among U.S. adults with diabetes, characterize factors associated with profile membership, and examine their clinical relevance. METHODS Data were from the 2022-2023 National Survey on Drug Use and Health (n = 89,889; 6805 with diabetes). Latent class analysis identified substance use profiles. Multinomial logistic regression examined demographic, socioeconomic, and mental health characteristics associated with profile membership. Weighted regression models evaluated associations between membership and health indicators. RESULTS Three profiles emerged: Low/Non-Use (67.6%), Cannabis and Binge Drinking (24.4%), and Polysubstance Use (8.0%). Higher-risk membership was associated with male sex, mental health burden, and urban residence; marriage and college education were protective. Both higher-risk classes were more than twice as likely to report poor self-rated health. Polysubstance Use class members had significantly higher odds of hospitalization (OR = 1.46). CONCLUSIONS Substance use among adults with diabetes is heterogeneous and linked to measurably worse health status outcomes including poorer self-rated health and higher hospitalization risk. These findings support routine, risk-stratified screening for substance use and mental health in diabetes care and may help inform targeted interventions.
BACKGROUND:The RADAR (Reorganizing the Approach to Diabetes through the Application of Registries) project was launched to enhance type 2 diabetes (T2D) care and outcomes in on-reserve First Nations communities in Alberta, Canada. The objective of this study is to determine whether previously observed improvements in diabetes care outcomes were sustained over time in the communities that continued the program (continued communities) and whether these improvements were reproducible in new communities. METHODS:RADAR involved an innovative, culturally contextually grounded care model designed for First Nations people, which was deployed in a stepped-wedge design to communities. The primary outcome was a 10% improvement or persistence at target in A1C, systolic blood pressure (SBP), and/or LDL, using the intention-to-treat (ITT) framework. Outcomes were assessed in 3 continued communities at 3-, 4-, and 6- years post-implementation of the RADAR program. We provided the same intervention to 2 new communities and assessed outcomes at 1 year post-implementation (repeatability assessment). RESULTS:In 2024, 256 T2D patients were registered in RADAR, ranging from 28 to 86 individuals per community. The average age was 61 years (SD=11.7) with 57% females (N = 145). ITT analysis showed all 3 continued communities maintained high rates of primary endpoint achievement, with 94%, 100% and 92% of participants in each community achieving the primary endpoint (n = 174), respectively, relative to baseline (p < 0.001). After 1 year of RADAR in the 2 new communities (n = 28 and n = 54), the ITT combined endpoint was achieved in 82% and 91% of participants, respectively (p < 0.001). CONCLUSION:RADAR continues to be associated with high levels of achievement of the primary combined endpoint across communities and over time. This study shows promise that future RADAR implementation could be adapted, in collaboration with First Nation Health Managers, to other First Nations community settings.
AIMS:This study evaluated whether a gamified mHealth application (CareAide®) improves Health-Related Quality of Life (HRQoL) in Type 2 Diabetes Mellitus (T2DM) and whether this effect is mediated by medication adherence. METHODS:Prespecified secondary analysis of the T2DM cohort from a 6-month multicentre RCT (NCT06068309; N = 663; three Malaysian hospitals). Participants were randomised 1:1 to standard care or CareAide®. Adherence (MMAS-8), EQ-5D-5L utility (Malaysian value set), and AQoL-6D were assessed at baseline and 6 months. Simple mediation analysis (PROCESS Model 4; 5000 bootstraps) adjusted for baseline HRQoL. RESULTS:CareAide® significantly predicted higher MMAS-8 scores (mean difference +1.756; d = 1.638; p < 0.001). Higher MMAS-8 scores significantly predicted improved AQoL-6D utility (b = 0.024; p < 0.001). The direct effect on AQoL-6D was non-significant (p = 0.248). Bootstrapped indirect effect confirmed full mediation via AQoL-6D (0.042; 95% CI [0.024, 0.060]). A sensitivity analysis adjusting for baseline HbA1c confirmed full mediation (indirect = 0.034; 95% CI [0.015, 0.052]; n = 563). EQ-5D-5L utility showed a significant direct between-group difference at 6 months (p = 0.012) but did not operate as a mediation outcome. CONCLUSIONS:Medication adherence fully mediates the AQoL-6D HRQoL benefit of a gamified mHealth intervention in T2DM, as confirmed by both the primary and HbA1c-adjusted sensitivity analyses. These findings support integration of behaviourally informed digital adjuncts into routine primary diabetes care.
