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- Title
Balancing Risks in the Choice of Medications for Diabetics with Alcohol Use Disorders: Physicians Prefer Insulin and Sulfonylureas.
- Authors
Miller, Donald R.; Smith, Peter C.; Berlowitz, Dan R.
- Abstract
Deciding on a medical regimen for diabetes patients with an alcohol use disorder (AUD), clinicians must balance the risks of hypoglycemia from insulin and sulfonylureas with the risk of liver toxicity from thiazolidinediones (TZD) and lactic acidosis from metformin. We describe the medical regimens of diabetics with and without an AUD. We analyzed a national database containing pharmacy, laboratory, and other medical data of patients with diabetes served by the Veteran Health Administration. We identified those who had an elevated HbA1C (>8 mg/dL) and were thus candidates for the addition of a new medication. We used multivariate logistic regression models to calculate the odds of having one of four classes of medications (sulfonylureas, metformin, TZD, and insulin) added to a subject's medication regimen, after adjusting for age and comorbidities. Of the 124,654 subjects who met our inclusion criteria, 4,818 (3.7%) were categorized as having an AUD. Among those subjects who were on no medications at baseline, and who had an oral medication added following the elevated HbA1C (n=9,173), diabetes patients with an AUD were 20% less likely to be started on metformin (OR 0.80, 95%CI 0.63-1.00) than on a sulfonylurea, and 62% less likely to be started on a TZD (OR 0.38, 95% CI 0.12-1.22) than on a sulfonylurea, when compared to those without an AUD. In subjects whose baseline regimen consisted of metformin and a sulfonylurea, and who had either insulin or a TZD added to their regimen (n=6,375), diabetics with an AUD were 72% more likely to be started on insulin (OR 1.72, 95% CI 1.29-2.31). When faced with the dilemma of choosing a medication regimen for diabetes patients with an alcohol use disorder, physicians are more likely to use insulin and sulfonylureas, and less likely to use TZD and metformin.
- Publication
Diabetes, 2007, Vol 56, pA577
- ISSN
0012-1797
- Publication type
Academic Journal