Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, T6G 2H7, Canada.
Alberta Diabetes Institute, University of Alberta, 1-005 Li Ka Shing Centre for Health Research Innovation, Edmonton, Alberta, T6G 2E1, Canada.
Diabet Med. 2021 Feb;38(2):e14426. doi: 10.1111/dme.14426. Epub 2020 Nov 2.
The association between depression and poor medication adherence is based on cross-sectional studies and cohort studies that measure adherence rates after depression status is determined. However, depressive symptoms occur well before diagnosis. This study examined adherence patterns in the year before a depressive episode.
This retrospective cohort study followed new metformin users identified in Alberta Health's administrative data between 2008 and 2018. Depressive episodes starting ≥1 year after metformin initiation were identified using a validated case definition. Controls were randomly assigned a pseudo depression date. Adherence to oral antihyperglycemic medications was estimated using proportion of days covered (PDC) and group-based trajectory models to explore the association between depression and poor adherence (PDC<0.8).
A depressive episode occurred in 17,418 (10.6%) of 165,056 new metformin users. Individuals with depression were more likely to have poor adherence compared to controls (adjusted odds ratio 1.21; 95% CI 1.17, 1.26). Five trajectories were identified: nearly perfect adherence (PDC >0.95 [34.8% of cohort]), discontinued (PDC=0 [18.3% of cohort], poor initial adherence (PDC 0.75) that declined either rapidly (9.2% of cohort) or gradually (30.1% of cohort), and poor initial adherence (PDC 0.26) that increased gradually (7.6% of cohort). Individuals with depression were more likely to be in one of the four trajectories of poor adherence compared to controls (adjusted odds ratio 1.24; 95% CI 1.19-1.29).
Poor medication adherence occurs in the year before a depressive episode; therefore, poor medication use patterns could be used as an early warning sign for depression.
抑郁与药物治疗依从性差之间的关联基于横断面研究和队列研究，这些研究在确定抑郁状态后测量药物治疗依从率。然而，抑郁症状早在诊断之前就出现了。本研究检查了抑郁发作前一年的药物治疗依从模式。
本回顾性队列研究跟踪了 2008 年至 2018 年期间在艾伯塔省卫生保健管理数据中确定的新使用二甲双胍的患者。使用经过验证的病例定义确定开始使用二甲双胍后≥1 年的抑郁发作。对照者随机分配一个伪抑郁日期。使用比例天数覆盖（PDC）和基于群组的轨迹模型来估计口服抗高血糖药物的依从性，以探讨抑郁与药物治疗依从性差（PDC<0.8）之间的关系。
在 165056 例新使用二甲双胍的患者中，17418 例（10.6%）发生了抑郁发作。与对照组相比，患有抑郁的个体更有可能药物治疗依从性差（校正比值比 1.21；95%CI 1.17，1.26）。确定了五个轨迹：近乎完美的依从性（PDC >0.95[队列的 34.8%]）、停止治疗（PDC=0[队列的 18.3%]）、初始药物治疗依从性差（PDC 0.75），快速下降（队列的 9.2%）或逐渐下降（队列的 30.1%），以及初始药物治疗依从性差（PDC 0.26），逐渐增加（队列的 7.6%）。与对照组相比，患有抑郁的个体更有可能处于药物治疗依从性差的四个轨迹之一（校正比值比 1.24；95%CI 1.19-1.29）。
在抑郁发作前一年就出现了药物治疗依从性差；因此，不良的药物使用模式可以作为抑郁的早期预警信号。
