Kalsekar Iftekhar D, Madhavan Suresh S, Amonkar Mayur M, Douglas Stratford M, Makela Eugene, Elswick Betsy L Meredith, Scott Virginia
Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, Indiana 46208-3485, USA.
Clin Ther. 2006 Feb;28(2):306-18. doi: 10.1016/j.clinthera.2006.02.005.
Oral hypoglycemic agents (OHAs) are an important component in the management of type 2 diabetes mellitus (DM). Large-scale studies have demonstrated that tight glycemic control with such agents can reduce the frequency and severity of long-term DM-related complications.
The main goal of this study was to examine the impact of depression on utilization patterns of OHAs in patients newly diagnosed with type 2 DM. A secondary objective was to estimate the impact of depression on discontinuation and modification of pharmacotherapy for DM in these patients.
Patients newly diagnosed with type 2 DM during a 3-year period (1998-2000) were identified from a Medicaid claims database. Presence of preexisting depression was determined on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The patient cohort was followed up until they received their first prescription for an OHA (1998-2001); this date was treated as the index date for the study. Utilization patterns (ie, discontinuation, augmentation, switching, non-modification) for OHAs were computed for a 12-month follow-up period after the index date. A multivariate framework was used to estimate the impact of depression on utilization patterns, controlling for confounders such as demographics, comorbidity, provider interaction, drug regimen complexity, and DM severity.
A total of 1237 newly diagnosed type 2 DM patients were identified (depressed, n=446; nondepressed, n=791). A higher number of depressed patients (23.32%) switched or augmented therapy compared with nondepressed patients (16.18%). Also, a higher fraction of depressed patients (39.46%) discontinued OHA therapy compared with nondepressed patients (32.87%). Results of a multinomial logistic regression indicated that, controlling for covariates, patients with depression were 1.72 times more likely to switch (P=0.046) and 1.89 times more likely to augment therapy (P=0.004) compared with nondepressed patients. Logistic regression analysis also indicated that, controlling for confounding covariates, patients with depression were 1.72 times more likely to modify initial OHA therapy compared with patients without depression (P=0.003).
Depression was significantly associated with utilization patterns of OHAs in these patients newly diagnosed with type 2 DM, thus possibly affecting their disease management.
口服降糖药（OHAs）是2型糖尿病（DM）管理的重要组成部分。大规模研究表明，使用此类药物严格控制血糖可降低长期糖尿病相关并发症的发生频率和严重程度。
本研究的主要目的是探讨抑郁症对新诊断的2型糖尿病患者口服降糖药使用模式的影响。次要目的是评估抑郁症对这些患者糖尿病药物治疗中断和调整的影响。
从医疗补助索赔数据库中识别出在3年期间（1998 - 2000年）新诊断为2型糖尿病的患者。根据《国际疾病分类，第九版，临床修订本》诊断编码确定是否存在既往抑郁症。对患者队列进行随访，直至他们首次开具口服降糖药处方（1998 - 2001年）；该日期被视为研究的索引日期。在索引日期后的12个月随访期内计算口服降糖药的使用模式（即停药、增加剂量、换药、未调整）。采用多变量框架来评估抑郁症对使用模式的影响，同时控制诸如人口统计学、合并症、医患互动、药物治疗方案复杂性和糖尿病严重程度等混杂因素。
共识别出1237例新诊断的2型糖尿病患者（抑郁症患者446例，非抑郁症患者791例）。与非抑郁症患者（16.18%）相比，更多的抑郁症患者（23.32%）更换或增加了治疗。此外，与非抑郁症患者（32.87%）相比，更高比例的抑郁症患者（39.46%）停用了口服降糖药治疗。多项逻辑回归结果表明，在控制协变量的情况下，与非抑郁症患者相比，抑郁症患者换药的可能性高1.72倍（P = 0.046），增加治疗的可能性高1.89倍（P = 0.004）。逻辑回归分析还表明，在控制混杂协变量的情况下，与无抑郁症患者相比，抑郁症患者调整初始口服降糖药治疗的可能性高1.72倍（P = 0.003）。
抑郁症与这些新诊断的2型糖尿病患者口服降糖药的使用模式显著相关，从而可能影响他们的疾病管理。
