Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Diabetologia. 2021 Feb;64(2):361-374. doi: 10.1007/s00125-020-05303-4. Epub 2020 Oct 19.
AIMS/HYPOTHESIS: We aimed to assess whether current antidepressant therapy or a history of hospital-diagnosed depression affects diabetes treatment initiation, adherence, and HbA and LDL-cholesterol target achievement.
In this register-based study, we included all individuals from Central and Northern Denmark with newly diagnosed type 2 diabetes, defined as a first-ever HbA measurement of ≥48 mmol/mol (6.5%), between 2000 and 2016. Individuals either diagnosed with depression at a psychiatric hospital in the 2 years prior to their diabetes diagnosis or currently receiving treatment with an antidepressant were compared with individuals with type 2 diabetes, but without depression treatment or previous history of depression. Outcome measures included initiation of glucose-lowering drugs and lipid-modifying agents, adherence to these medications (medication possession ratio >80%), and HbA (<53 mmol/mol [7%]) and LDL-cholesterol (<2.6 mmol/l) target achievement. The assessment of association between depression or antidepressant treatment and these outcomes was conducted using regression analyses with adjustment for potential confounders.
We included a total of 87,650 individuals with first-ever HbA-diagnosed type 2 diabetes, of whom 0.9% (n = 784) had hospital-diagnosed depression and 11.4% (n = 9963) currently received antidepressant treatment. Compared with those without depression treatment, treatment with an antidepressant was associated with increased likelihood of glucose-lowering drug initiation (HR 1.39 [95% CI 1.34, 1.44]) and adherence (OR 1.27 [95% CI 1.18, 1.36]), lipid-modifying agent initiation (HR 1.17 [95% CI 1.11, 1.23]) and adherence (OR 1.25 [95% CI 1.09, 1.43]), and achievement of LDL (OR 1.08 [95% CI 1.03, 1.14]) but not HbA target (OR 0.99 [95% CI 0.93, 1.06]). The findings were similar for individuals who had hospital-diagnosed depression.
CONCLUSIONS/INTERPRETATION: In individuals with newly diagnosed type 2 diabetes, antidepressant treatment and depression were associated with improved diabetes treatment quality. Graphical abstract.
目的/假设：我们旨在评估当前抗抑郁治疗或既往医院诊断的抑郁症是否会影响糖尿病的起始治疗、治疗依从性以及糖化血红蛋白和 LDL 胆固醇目标的达标情况。
在这项基于登记的研究中，我们纳入了 2000 年至 2016 年期间在丹麦中北部首次确诊为 2 型糖尿病的所有患者，其定义为首次糖化血红蛋白测量值≥48mmol/mol（6.5%）。将在糖尿病诊断前 2 年内曾在精神病院诊断为抑郁症的患者或正在接受抗抑郁治疗的患者与未接受抑郁症治疗或既往无抑郁症病史的患者进行比较。主要结局指标包括血糖降低药物和调脂药物的起始使用、这些药物的使用依从性（用药比例＞80%）以及糖化血红蛋白（＜53mmol/mol[7%]）和 LDL 胆固醇（＜2.6mmol/l）目标的达标情况。使用调整了潜在混杂因素的回归分析来评估抑郁症或抗抑郁治疗与这些结局之间的关联。
我们共纳入了 87650 例首次接受糖化血红蛋白诊断的 2 型糖尿病患者，其中 0.9%（n=784）有医院诊断的抑郁症，11.4%（n=9963）正在接受抗抑郁治疗。与未接受抑郁症治疗的患者相比，抗抑郁治疗与以下可能性增加相关：使用降糖药物（HR 1.39[95%CI 1.34, 1.44]）和使用依从性（OR 1.27[95%CI 1.18, 1.36]）、使用调脂药物（HR 1.17[95%CI 1.11, 1.23]）和使用依从性（OR 1.25[95%CI 1.09, 1.43]）、以及 LDL 目标达标（OR 1.08[95%CI 1.03, 1.14]），但与糖化血红蛋白目标达标无关（OR 0.99[95%CI 0.93, 1.06]）。在有医院诊断的抑郁症的患者中，也观察到了类似的结果。
结论/解释：在新诊断为 2 型糖尿病的患者中，抗抑郁治疗和抑郁症与改善糖尿病治疗质量有关。
