抑郁药物对伴发抑郁的糖尿病患者口服抗糖尿病药物依从性的影响。
The impact of depression medications on oral antidiabetic drug adherence in patients with diabetes and depression.
机构信息
University of Illinois at Chicago, Department of Pharmacy, Systems, Outcomes and Policy, College of Pharmacy, United States.
University of Illinois at Chicago, Department of Psychiatry, College of Medicine, United States; University of Illinois at Chicago, Department of Bioengineering, College of Engineering, College of Medicine, United States.
出版信息
J Diabetes Complications. 2018 May;32(5):492-500. doi: 10.1016/j.jdiacomp.2017.12.008. Epub 2017 Dec 27.
AIMS
To compare adherence and persistence to oral antidiabetic drugs (OAD) between patients who are new users of second generation antipsychotics (SGA) versus new users of other depression therapies in adults with type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD).
METHODS
Adults 18-64 years with previously-treated T2DM and MDD (past OAD and SSRI/SNRI use) who are new users of SGA or non-SGA therapies (bupropion, lithium, mirtazapine, thyroid hormone, tricyclic antidepressant) were identified in the 2009-2015 MarketScan® Commercial Claims and Encounters database. Multivariate regression models were used to determine the odds of a ≥10% decline in OAD adherence over 180- and 365-days, and time to OAD discontinuation, adjusting for differences between groups.
RESULTS
A total of 8664 (21.5% SGA), 8311 (22.1% SGA), and 17,524 (21.3% SGA) patients met inclusion criteria for the 180-day adherence, 365-day adherence, and persistence cohorts, respectively. Over 180-days, 16.6% of SGA and 13.3% of non-SGA initiators had a ≥10% decline in OAD adherence (adjusted odds ratio [OR] = 1.41, 95% CI 1.21-1.63). Over 365-days, 22.3% of SGA and 18.9% of non-SGA initiators had a ≥ 10% decline (OR = 1.34, 95% CI 1.17-1.53). Time to OAD discontinuation was similar between groups (adjusted hazard ratio = 1.03, 95% CI 0.94-1.12).
CONCLUSION
Use of SGA was associated with a 1.3-1.4 times higher odds of a ≥10% decline in OAD adherence. Adherence to OAD is critical for optimal diabetes control and reductions in this magnitude may impact A1C. Close monitoring of OAD adherence after SGA initiation is warranted.
目的
比较 2 型糖尿病（T2DM）和重度抑郁症（MDD）成年患者中新使用第二代抗精神病药物（SGA）与新使用其他抗抑郁药物的患者在口服抗糖尿病药物（OAD）治疗中的依从性和持久性。
方法
从 2009 年至 2015 年 MarketScan®商业索赔和遭遇数据库中确定了先前接受过 T2DM 治疗且患有 MDD（过去使用过 OAD 和 SSRI/SNRI）的 18-64 岁成年人，他们是 SGA 或非 SGA 治疗药物（安非他酮、锂、米氮平、甲状腺激素、三环类抗抑郁药）的新使用者。使用多变量回归模型来确定 OAD 治疗依从性在 180 天和 365 天下降≥10%的几率，以及调整组间差异后的 OAD 停药时间。
结果
共有 8664 例（21.5%的 SGA）、8311 例（22.1%的 SGA）和 17524 例（21.3%的 SGA）患者分别符合 180 天依从性、365 天依从性和持久性队列的纳入标准。在 180 天内，16.6%的 SGA 和 13.3%的非 SGA 使用者的 OAD 治疗依从性下降≥10%（调整后的优势比[OR]为 1.41，95%CI 为 1.21-1.63）。在 365 天内，22.3%的 SGA 和 18.9%的非 SGA 使用者的 OAD 治疗依从性下降≥10%（OR 为 1.34，95%CI 为 1.17-1.53）。两组之间的 OAD 停药时间相似（调整后的风险比为 1.03，95%CI 为 0.94-1.12）。
结论
使用 SGA 与 OAD 治疗依从性下降≥10%的几率增加 1.3-1.4 倍相关。OAD 的依从性对于最佳的糖尿病控制至关重要，这种幅度的下降可能会影响 A1C。在开始使用 SGA 后，需要密切监测 OAD 的依从性。
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