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Intravenous drug abuse and Type 1 diabetes: financial and healthcare implications

2004; Wiley; Volume: 21; Issue: 12 Linguagem: Inglês

10.1111/j.1464-5491.2004.01325.x

1464-5491

Simon Saunders, Jane Democratis, Jilly Martin, I A MacFarlane,

Alcohol Consumption and Health Effects

Abstract Aims To determine the morbidity, mortality and healthcare costs of intravenous drug‐abusing patients with Type 1 diabetes (IVDA‐DM), who are admitted to hospital. Methods Retrospective case note analysis of admissions, complications and cost estimation over a 6‐year period. Each drug‐abusing patient (IVDA‐DM) ( n = 9) was compared with two controls ( n = 18) with Type 1 diabetes but without a history of intravenous drug abuse (DM‐controls). Admissions were also analysed for patients with intravenous drug abuse, but without Type 1 diabetes (IVDA‐controls) ( n = 198). Admissions were at a University teaching hospital in Liverpool, UK. DM‐controls were drawn from a population attending diabetes outpatient clinics between 1997 and 2002 at the same hospital. The main outcome measures were: the duration and healthcare costs of hospital admissions per year, outpatient attendances per year, glycated haemoglobin (HbA 1c ), weight, micro‐ and macrovascular complications and mortality. Results Multiple admissions, mainly related to ketoacidosis, led to marked differences in mean (95% CI) inpatient days per year per patient [IVDA‐DM 28.1 (13.6–42.7) vs. DM‐control 1.1 (0.2–1.9); P < 0.0001], mean inpatient days per year per patient in critical care bed (IVDA‐DM 1.7 (−0.7–4.2) vs. DM‐control 0; P < 0.02) and mean costs of admission, per patient per year (£7320 vs. £230). The IVDA‐DM group frequently omitted insulin, were underweight, failed to attend as outpatients and five had died by the end of 2002. The IVDA‐controls spent considerably less time in hospital [3.4 (2.8–3.9) days per patient per year]. Conclusion IVDA‐DM patients have higher rates of diabetes complications, are admitted more frequently and have a high mortality compared with DM and IVDA‐controls. The cost of inpatient care of this small group of patients was considerable.