Cheeloo College of Medicine, Shandong University, Jinan 250012, China; Shandong Collaborative Innovation Center for Diagnosis, Treatment & Behavioral Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jining 272013, China; Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining 272013, China; Center of Evidence-Based Medicine, Jining Medical University, Jining 272013, China.
Shandong Collaborative Innovation Center for Diagnosis, Treatment & Behavioral Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jining 272013, China; Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining 272013, China; Center of Evidence-Based Medicine, Jining Medical University, Jining 272013, China.
J Affect Disord. 2021 May 15;287:41-53. doi: 10.1016/j.jad.2021.03.023. Epub 2021 Mar 13.
This study aimed at examining the effects of different antidepressants on the new onset of T2DM.
Systematic literature retrieval for cohort and case-control studies was conducted in PubMed, Embase, Web of Science, Cochrane library, Clinical Trials Register of the Cochrane Collaboration and CENTRAL published from January 2000 to October 2020. Pooled estimates were calculated and subgroup analyses were conducted by a fixed or random effects model according to the heterogeneity. Funnel plots and Egger's test were performed to evaluate publication bias. Stata Version 15.1 was used for data analysis.
Thirty studies (24 cohort, 4 nested case-control and 2 case-control studies) were included covering 2,875,567 participants with the follow-up periods from 1 year to 18 years (Median=8.4 years). The pooled estimates of antidepressants use and new-onset T2DM were HR=1.24 (95% CI: 1.18, 1.31), RR=1.42 (95% CI: 0.99, 2.05) and OR=1.17 (95% CI: 1.03, 1.32), respectively. However, subgroup analyses showed that only tricyclic antidepressants (TCAs) use was positively associated with the new onset of T2DM in both cohort studies (combined RR=1.39, 95% CI: 1.17, 1.65) and case-control studies (combined OR=1.25, 95% CI: 1.05, 1.50). Moreover, the risk of T2DM was increased with the duration of antidepressants use in a linear trend (R= 88.51%, P = 0.009).
Heterogeneity might impact the results and inference.
Antidepressants use might be a risk factor for the new onset of T2DM. Patients with long-term antidepressants use should be evaluated cautiously for T2DM risk. Routine T2DM screening is necessary in antidepressants users.
本研究旨在探讨不同抗抑郁药对 2 型糖尿病新发病例的影响。
系统检索了 2000 年 1 月至 2020 年 10 月期间在 PubMed、Embase、Web of Science、Cochrane 图书馆、Cochrane 协作临床试验注册中心和 CENTRAL 发表的队列研究和病例对照研究的文献。根据异质性，采用固定或随机效应模型计算合并估计值，并进行亚组分析。采用漏斗图和 Egger 检验评估发表偏倚。使用 Stata 版本 15.1 进行数据分析。
共纳入 30 项研究（24 项队列研究、4 项巢式病例对照研究和 2 项病例对照研究），共纳入 2875567 名参与者，随访时间为 1 年至 18 年（中位数=8.4 年）。抗抑郁药使用与 2 型糖尿病新发病例的合并估计值分别为 HR=1.24（95%CI：1.18，1.31）、RR=1.42（95%CI：0.99，2.05）和 OR=1.17（95%CI：1.03，1.32）。然而，亚组分析显示，只有三环类抗抑郁药（TCAs）的使用与队列研究（合并 RR=1.39，95%CI：1.17，1.65）和病例对照研究（合并 OR=1.25，95%CI：1.05，1.50）中 2 型糖尿病的新发病例呈正相关。此外，抗抑郁药使用时间与 2 型糖尿病风险呈线性趋势相关（R=88.51%，P=0.009）。
异质性可能影响结果和推论。
抗抑郁药的使用可能是 2 型糖尿病新发病例的一个危险因素。长期使用抗抑郁药的患者应谨慎评估 2 型糖尿病风险。在使用抗抑郁药的患者中，常规进行 2 型糖尿病筛查是必要的。
