3. Discussion
An estimated 29.1 million people or 9.3% of the U.S. population have
diabetes [12]. The total estimated cost of diagnosed diabetes was $245
billion in 2012, which reflects a 41% increase from a prior estimate in
2007. The largest components of medical expenditures are inpatient
care [15]. Adults who have diabetes with complications or SUD tend
to use more inpatient care than those without these diagnoses [21,22].
Cigarette smoking, heavy alcohol use, and alcohol/drug use disorder increase
the likelihood of medical complications [16]. Determining a feasible
means of incorporating SBIRT into diabetes care can help
minimize SUD-related consequences and reduce morbidity and costs.
The Substance Abuse and Mental Health Services Administration leads
efforts to advance the behavioral health of people in the U.S. and has issued
an advisory to encourage integrating diabetic care into behavioral
healthcare settings [8]. Yet empirical data are needed to guide integration
of SBIRT into primary care settings that treat medical conditions
with high morbidity and mortality [56,57]. In line with the Institute of
Medicine's vision for pursuing pragmatic clinical research in real-life
settings to inform the development of learning healthcare systems
[58], our study is designed to provide such first-hand clinical information
about feasibility and potential challenges in conducting SBIRT
among high-risk diabetic patients who have a pressing need for behavioral
health interventions and care coordination.