Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
Department of Medical Technology, School of Health Science, Tokyo University of Technology, Tokyo, Japan.
Diabetes Care. 2020 Apr;43(4):885-893. doi: 10.2337/dc19-1175. Epub 2020 Feb 12.
This study aimed to reveal the associations between the risk of new-onset type 2 diabetes and the duration of antidepressant use and the antidepressant dose, and between antidepressant use after diabetes onset and clinical outcomes.
In this large-scale retrospective cohort study in Japan, new users of antidepressants (exposure group) and nonusers (nonexposure group), aged 20-79 years, were included between 1 April 2006 and 31 May 2015. Patients with a history of diabetes or receipt of antidiabetes treatment were excluded. Covariates were adjusted by using propensity score matching; the associations were analyzed between risk of new-onset type 2 diabetes and the duration of antidepressant use/dose of antidepressant in the exposure and nonexposure groups by using Cox proportional hazards models. Changes in glycated hemoglobin (HbA) level were examined in groups with continuous use, discontinuation, or a reduction in the dose of antidepressants.
Of 90,530 subjects, 45,265 were in both the exposure and the nonexposure group after propensity score matching; 5,225 patients (5.8%) developed diabetes. Antidepressant use was associated with the risk of diabetes onset in a time- and dose-dependent manner. The adjusted hazard ratio was 1.27 (95% CI 1.16-1.39) for short-term low-dose and 3.95 (95% CI 3.31-4.72) for long-term high-dose antidepressant use. HbA levels were lower in patients who discontinued or reduced the dose of antidepressants ([2,49] = 8.17; < 0.001).
Long-term antidepressant use increased the risk of type 2 diabetes onset in a time- and dose-dependent manner. Glucose tolerance improved when antidepressants were discontinued or the dose was reduced after diabetes onset.
本研究旨在揭示新型 2 型糖尿病发病风险与抗抑郁药使用持续时间和剂量之间的关系，以及糖尿病发病后使用抗抑郁药与临床结局之间的关系。
在这项日本的大规模回顾性队列研究中，纳入了 20-79 岁的新型抗抑郁药使用者（暴露组）和非使用者（非暴露组），于 2006 年 4 月 1 日至 2015 年 5 月 31 日期间纳入研究。排除了有糖尿病病史或接受糖尿病治疗的患者。采用倾向评分匹配调整协变量；采用 Cox 比例风险模型分析暴露组和非暴露组中抗抑郁药使用持续时间/剂量与新发 2 型糖尿病风险之间的关系。在连续使用、停药或减少抗抑郁药剂量的组中检查糖化血红蛋白（HbA）水平的变化。
在 90530 名患者中，经过倾向评分匹配后，45265 名患者同时进入暴露组和非暴露组；5225 名患者（5.8%）发生糖尿病。抗抑郁药的使用与糖尿病发病的风险呈时间和剂量依赖性相关。调整后的危险比（HR）为短期低剂量组 1.27（95%CI 1.16-1.39）和长期高剂量组 3.95（95%CI 3.31-4.72）。停药或减少抗抑郁药剂量的患者 HbA 水平较低（[2,49] = 8.17；<0.001）。
长期抗抑郁药使用与 2 型糖尿病发病的风险呈时间和剂量依赖性相关。糖尿病发病后停止使用抗抑郁药或减少剂量可改善血糖耐量。
