Derijks Hieronymus J, Heerdink Eibert R, De Koning Fred H, Janknegt Robert, Klungel Olaf H, Egberts Antoine C
Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands.
Pharmacoepidemiol Drug Saf. 2008 Apr;17(4):336-44. doi: 10.1002/pds.1562.
Hypoglycaemia is a limiting factor for glycaemic management of diabetes with intensive insulin and/or oral antidiabetic drug (OAD) regimen. Case reports suggest that antidepressants may interfere with blood glucose metabolism in patients with diabetes mellitus potentially increasing the risk of clinically relevant hypoglycaemia. Comorbid depression treated with antidepressants could therefore further complicate glycaemic control. We have carried out a nested case-control study among diabetic patients to assess the risk of hypoglycaemia requiring hospitalisation associated with the use of antidepressants.
Diabetic patients treated with insulin and/or OADs were selected from the Dutch Pharmo system. Exposure to antidepressants was the primary determinant investigated. Use of antidepressants was further subclassified based on the receptor binding profile to investigate whether specific pharmacological properties could explain a potential influence on glucose homeostasis. Conditional logistic regression was used to estimate odds ratios and to adjust for confounding factors.
From the base cohort (40 600 patients), 549 (1.35%) cases were identified and 1897 controls were selected. Current use of any antidepressant was not associated with a significantly higher risk of hypoglycaemia requiring hospitalisation (OR: 1.36 (95%CI: 0.84-2.20)). A trend for a higher risk on hypoglycaemia was identified for antidepressants with high affinity for the serotonin reuptake transporter. The risk on severe hypoglycaemia was increased after 3 years of use (OR: 2.75 (95%CI: 1.31-5.77)).
It is important for diabetic patients using antidepressants for more than 3 years to pay attention for symptoms of hypoglycaemia and strict blood glucose self-monitoring.
低血糖是强化胰岛素和/或口服抗糖尿病药物（OAD）治疗方案中糖尿病血糖管理的一个限制因素。病例报告表明，抗抑郁药可能会干扰糖尿病患者的血糖代谢，从而可能增加临床相关低血糖的风险。因此，使用抗抑郁药治疗合并的抑郁症可能会使血糖控制进一步复杂化。我们在糖尿病患者中开展了一项巢式病例对照研究，以评估使用抗抑郁药与需要住院治疗的低血糖风险之间的关系。
从荷兰Pharmo系统中选取接受胰岛素和/或OAD治疗的糖尿病患者。抗抑郁药的使用是主要研究的决定因素。根据受体结合情况对抗抑郁药的使用进行进一步分类，以研究特定的药理特性是否可以解释对葡萄糖稳态的潜在影响。采用条件逻辑回归来估计比值比并对混杂因素进行校正。
从基础队列（40600名患者）中，识别出549例（1.35%）病例，并选取了1897名对照。当前使用任何抗抑郁药与需要住院治疗的低血糖风险显著升高无关（比值比：1.36（95%置信区间：0.84 - 2.20））。对于对5-羟色胺再摄取转运体具有高亲和力的抗抑郁药，发现有低血糖风险增加的趋势。使用3年后严重低血糖风险增加（比值比：2.75（95%置信区间：1.31 - 5.77））。
使用抗抑郁药超过3年的糖尿病患者注意低血糖症状并严格进行血糖自我监测很重要。
