J Clin Psychopharmacol. 2022;42(2):125-132. doi: 10.1097/JCP.0000000000001508.
PURPOSE/BACKGROUND: Data on the effect of treatment with antidepressant drugs on metabolic control in diabetes are sparse. In this controlled within-subject before-after study, the impact of initiation and discontinuation of antidepressant treatment on hemoglobin A1c (HbA1c) and low-density lipoprotein (LDL) levels in type 2 diabetes was estimated.
METHODS/PROCEDURES: All individuals with newly developed type 2 diabetes (first HbA1c ≥ 6.5%) between 2000 and 2016 in Northern and Central Denmark were identified using register-based health care data. Among these, we identified individuals initiating and discontinuing antidepressant treatment. Using a within-subject before-after design, we examined HbA1c and LDL in the 16 months leading up to and the 16 months after antidepressant treatment initiation or discontinuation, respectively. For comparison, we ran similar time trend analyses in a reference population of age- and sex-matched type 2 diabetes individuals not receiving antidepressant treatment.
FINDINGS/RESULTS: Mean HbA1c decreased after initiation of antidepressant treatment (-0.16%; 95% confidence interval [CI], -0.18 to -0.13%). In the reference population, no material change in HbA1c over time (-0.03%; 95% CI, -0.04 to -0.01%) was seen. Mean LDL decreased not only in antidepressant initiators (-0.17 mmol/L; 95% CI, -0.19 to -0.15 mmol/L) but also in the reference population (-0.15 mmol/L; 95% CI, -0.16 to -0.13 mmol/L). Among antidepressant discontinuers, there was also a decrease in HbA1c (-0.32%; 95% CI, -0.37 to -0.28%), with no change in the reference population (-0.02%; 95% CI, -0.04 to 0.00%). Decreases in LDL were found both in antidepressant discontinuers (-0.09 mmol/L; 95% CI, -0.14 to -0.04 mmol/L) and in the reference population (-0.16 mmol/L0; 95% CI, -0.18 to -0.13 mmol/L).
IMPLICATIONS/CONCLUSIONS: Antidepressant treatment in type 2 diabetes may have a beneficial effect on glycemic control, as the decrease in HbA1c after discontinuation of antidepressants likely reflects remission of depression. Conversely, antidepressant treatment does not seem to affect LDL levels.
目的/背景：关于抗抑郁药物治疗对糖尿病代谢控制影响的数据很少。在这项对照、自身前后研究中，估计了 2 型糖尿病患者开始和停止抗抑郁治疗对糖化血红蛋白（HbA1c）和低密度脂蛋白（LDL）水平的影响。
方法/程序：使用基于登记的医疗保健数据，确定了 2000 年至 2016 年期间在丹麦北部和中部新诊断为 2 型糖尿病（首次 HbA1c≥6.5%）的所有患者。在这些患者中，我们确定了开始和停止抗抑郁治疗的患者。使用自身前后设计，我们分别检查了抗抑郁治疗开始前和开始后 16 个月的 HbA1c 和 LDL。为了比较，我们在未接受抗抑郁治疗的年龄和性别匹配的 2 型糖尿病患者的参考人群中进行了类似的时间趋势分析。
结果/发现：抗抑郁治疗开始后 HbA1c 降低（-0.16%；95%置信区间[CI]，-0.18 至-0.13%）。在参考人群中，HbA1c 随时间没有明显变化（-0.03%；95%CI，-0.04 至-0.01%）。不仅在抗抑郁药起始者中（-0.17mmol/L；95%CI，-0.19 至-0.15mmol/L），而且在参考人群中（-0.15mmol/L；95%CI，-0.16 至-0.13mmol/L），LDL 也降低。在抗抑郁药停药者中，HbA1c 也有下降（-0.32%；95%CI，-0.37 至-0.28%），而参考人群中没有变化（-0.02%；95%CI，-0.04 至 0.00%）。在抗抑郁药停药者中（-0.09mmol/L；95%CI，-0.14 至-0.04mmol/L）和参考人群中（-0.16mmol/L；95%CI，-0.18 至-0.13mmol/L），LDL 也降低。
结论/意义：在 2 型糖尿病患者中使用抗抑郁药物治疗可能对血糖控制有有益影响，因为抗抑郁药停药后 HbA1c 的降低可能反映了抑郁的缓解。相反，抗抑郁药物治疗似乎不会影响 LDL 水平。
