Pharmacoepidemiol Drug Saf. 2013 Jun;22(6):615-22. doi: 10.1002/pds.3424.
This study aimed to examine the effect of antidepressant use on persistence with newly initiated oral antidiabetic medicines in older people.
A retrospective study of administrative claims data from the Australian Government Department of Veterans' Affairs, from 1 July 2000 to 30 June 2008 of new users of oral antidiabetic medicines (metformin or sulfonylurea). Antidepressant medicine use was determined in the 6 months preceding the index date of the first dispensing of an oral antidiabetic medicine. The outcome was time to discontinuation of diabetes therapy in those with antidepressant use compared with those without. Competing risks regression analyses were conducted with adjustment for covariates.
A total of 29,710 new users of metformin or sulfonylurea were identified, with 7171 (24.2%) dispensed an antidepressant. Median duration of oral antidiabetic medicines was 1.81 years (95% CI 1.72–1.94) for those who received an antidepressant at the time of diabetes medicine initiation, by comparison to 3.23 years (95% CI 3.10–3.40) for those who did not receive an antidepressant. Competing risk analyses showed a 42% increased likelihood of discontinuation of diabetes medications in persons who received an antidepressant (subdistribution hazard ratio 1.42, 95% CI 1.37–1.47, p < 0.001).
The results of this large population-based study demonstrate that depression may be contributing to non-compliance with medicines for diabetes and highlight the need to provide additional services to support appropriate medicine use in those initiating diabetes medicines with co-morbid depression.
本研究旨在考察抗抑郁药的使用对老年人新起始口服抗糖尿病药物持续治疗的影响。
这是一项回顾性研究，使用了澳大利亚退伍军人事务部的行政索赔数据，时间范围为 2000 年 7 月 1 日至 2008 年 6 月 30 日，纳入新使用口服抗糖尿病药物（二甲双胍或磺酰脲类）的患者。在首次开出口服抗糖尿病药物前的 6 个月内确定抗抑郁药的使用情况。将有抗抑郁药使用的患者与无抗抑郁药使用的患者进行比较，观察其糖尿病治疗停药时间。采用竞争风险回归分析，并对协变量进行调整。
共纳入 29710 名新使用二甲双胍或磺酰脲类药物的患者，其中 7171 名（24.2%）患者开具了抗抑郁药。与未使用抗抑郁药的患者相比，在起始糖尿病药物治疗时使用抗抑郁药的患者，其口服抗糖尿病药物的中位持续时间为 1.81 年（95%CI 1.72-1.94），而未使用抗抑郁药的患者为 3.23 年（95%CI 3.10-3.40）。竞争风险分析显示，使用抗抑郁药的患者停药的可能性增加了 42%（亚分布风险比 1.42，95%CI 1.37-1.47，p<0.001）。
这项大型基于人群的研究结果表明，抑郁可能导致患者不遵医嘱使用治疗糖尿病的药物，这凸显了在开始使用抗糖尿病药物治疗的同时伴有共病性抑郁的患者中，需要提供额外的服务来支持其合理用药。
