The Association Between Substance Use And Diabetes-Related Complications: A Systematic Review

Abstract

Substance use disorder, including alcohol, smoking, and polysubstance use, is a growing concern in the management of diabetes mellitus. Quantitative studies have determined a relationship between substance use and adverse diabetes outcomes. However, little is known about how patients with diabetes experience substance use and how it affects their self-management of diabetes and its complications. The review was guided by the research question: What are the lived experiences of individuals with diabetes mellitus regarding substance use disorder, and how do they perceive its impact on diabetes management and diabetes-related complications? This research aimed to synthesize qualitative evidence to gain a better understanding of the lived pathways by which substance use influences the outcome of diabetes.

A qualitative systematic review was conducted using a structured and transparent approach. An extensive systematic search strategy was conducted in databases like PubMed, CINAHL, Scopus, PsycINFO, and Web of Science to find qualitative studies published between 2014 and 2024. Quality methodological studies were selected, and the results were synthesized using thematic analysis to determine common patterns and meanings across the studies.

Eight qualitative studies that were based on adult participants with Type 1 and/or Type 2 diabetes and reporting the experience of alcohol use, smoking, cannabis use, or polysubstance use in a variety of healthcare and social settings were included in the review. Four main themes were found, including substance use as a coping strategy; disruption of diabetes self-management behaviors; perceived role of substance use in diabetes complications; and stigma, silence, and fragmented healthcare support.

The findings indicate that substance use disorder influences the complications of diabetes through complex psychosocial, behavioral, and healthcare-associated pathways as opposed to individual non-adherence. These insights underscore the need for integrating stigma-informed and person-centered care strategies to enhance the outcomes of diabetes in substance users.