Nau David P, Chao Jingdong, Aikens James E
Department of Social and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, MI 48109-1065, USA.
Res Social Adm Pharm. 2005 Sep;1(3):378-88. doi: 10.1016/j.sapharm.2005.06.001.
Many patients with diabetes experience depression, yet it is unclear if the treatment of depression in diabetic patients is concordant with national guidelines, and whether appropriate antidepressant use is associated with better diabetes self-care behaviors.
The purpose of this study was to (1) determine whether antidepressant medication use for managed care enrollees with type 2 diabetes was concordant with The Agency for Healthcare Research and Quality depression treatment guidelines; and (2) examine the relationship between guideline concordance and oral diabetes medication adherence.
Retrospective analyses were conducted using medical/pharmacy claims for 2001 from a managed care organization in the midwestern United States. Subjects were adults with type 2 diabetes treated with oral medications only. The subjects were divided into 3 groups: (1) guideline-concordant users of antidepressants; (2) those who received antidepressants not in concordance with the guidelines; and (3) nonusers of antidepressants. Antidepressant users were determined to be in concordance with the acute phase treatment guidelines if they filled at least 90 days supply of antidepressant drugs within 118 days of the first fill. Adherence to diabetes medications was measured by the medication possession ratio. A 1-way analysis of variance with Scheffe's test was used to compare the antihyperglycemic medication possession ratio across the three groups.
One hundred eighty-two (12.5%) of the 1454 subjects initiated treatment with antidepressants. Eighty-nine (48.9%) of the 182 antidepressant users were in concordance with the acute phase treatment guidelines. Subjects with subconcordant antidepressant use had a lower mean diabetes medication possession ratio than those with either guideline-concordant use or no use (F=14.3, P<.01).
Over half of the diabetic patients initiating treatment for depression did not receive therapy in concordance with the Agency for Healthcare Research and Quality guidelines. Patients whose antidepressant use was not concordant with the guidelines were also less adherent to diabetes medications.
许多糖尿病患者患有抑郁症，但目前尚不清楚糖尿病患者的抑郁症治疗是否符合国家指南，以及适当使用抗抑郁药是否与更好的糖尿病自我护理行为相关。
本研究的目的是：（1）确定2型糖尿病管理式医疗参保者使用抗抑郁药物的情况是否符合医疗保健研究与质量机构的抑郁症治疗指南；（2）研究指南依从性与口服降糖药依从性之间的关系。
使用美国中西部一家管理式医疗组织2001年的医疗/药房理赔数据进行回顾性分析。研究对象为仅接受口服药物治疗的2型糖尿病成年患者。研究对象被分为三组：（1）符合指南的抗抑郁药使用者；（2）接受不符合指南的抗抑郁药治疗者；（3）未使用抗抑郁药者。如果抗抑郁药使用者在首次配药后的118天内配足至少90天用量的抗抑郁药，则判定其符合急性期治疗指南。通过药物持有率来衡量糖尿病药物的依从性。采用单因素方差分析和谢费检验来比较三组患者的降糖药物持有率。
1454名研究对象中有182名（12.5%）开始使用抗抑郁药治疗。182名抗抑郁药使用者中有89名（48.9%）符合急性期治疗指南。抗抑郁药使用不完全符合指南的患者，其平均糖尿病药物持有率低于抗抑郁药使用符合指南或未使用抗抑郁药的患者（F=14.3，P<0.01）。
开始接受抑郁症治疗的糖尿病患者中，超过半数未接受符合医疗保健研究与质量机构指南的治疗。抗抑郁药使用不符合指南的患者，其糖尿病药物依从性也较低。
