Niaz Diva, Necyk Candace, Simpson Scot H
Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
Can J Diabetes. 2022 Oct;46(7):655-661. doi: 10.1016/j.jcjd.2022.03.002. Epub 2022 Apr 11.
Depression is a known risk factor for poor medication adherence, but it is unclear whether depression treatment affects adherence rates. In this study, we examined the association between pharmacologic treatment of a new depressive episode and subsequent adherence to oral antihyperglycemic medications.
In this retrospective cohort study, we used administrative health data to follow adult new metformin users in Alberta, Canada, between 2008 and 2018. Depressive episodes starting ≥1 year after metformin initiation were identified and individuals starting antidepressant treatment within the first 90 days were compared with those who did not. The proportion of days covered (PDC) with oral antihyperglycemic medications in the subsequent year (days 91 to 455) was used to estimate adherence. The association between antidepressant treatment and poor adherence (PDC<0.8) was examined using multivariate logistic regression models.
A new depressive episode occurred in 6,201 people, with a mean age of 56.0 (standard deviation [SD], 15.4) years. Of this cohort, 3,303 (53.2%) were women. Mean PDC was 0.55 (SD, 0.41); 924 (57.0%) of 1,621 people who started antidepressant treatment and 2,709 (59.2%) of 4,580 controls had poor adherence (p=0.13). After adjusting for baseline comorbidities and other characteristics, antidepressant treatment was associated with a lower likelihood of poor adherence (adjusted odds ratio, 0.85; 95% confidence interval, 0.75 to 0.96; p=0.007).
Although overall adherence to antihyperglycemic medications was low after onset of a depressive episode, antidepressant treatment was associated with a lower likelihood of poor adherence.
抑郁症是药物治疗依从性差的已知风险因素，但抑郁症治疗是否会影响依从率尚不清楚。在本研究中，我们探讨了新发性抑郁发作的药物治疗与随后口服降糖药物依从性之间的关联。
在这项回顾性队列研究中，我们利用行政健康数据对2008年至2018年期间加拿大艾伯塔省开始使用新二甲双胍的成年患者进行随访。识别出二甲双胍起始≥1年后开始的抑郁发作，并将在开始的90天内开始抗抑郁治疗的个体与未开始抗抑郁治疗的个体进行比较。使用随后一年（第91天至455天）口服降糖药物的覆盖天数比例（PDC）来评估依从性。使用多变量逻辑回归模型检查抗抑郁治疗与依从性差（PDC<0.8）之间的关联。
6201人发生了新发性抑郁发作，平均年龄为56.0岁（标准差[SD]，15.4）。在该队列中，3303人（53.2%）为女性。平均PDC为0.55（SD，0.41）；开始抗抑郁治疗的1621人中，924人（57.0%）依从性差，4580名对照者中有2709人（59.2%）依从性差（p=0.13）。在调整基线合并症和其他特征后，抗抑郁治疗与依从性差的可能性较低相关（调整后的优势比，0.85；95%置信区间，0.75至0.96；p=0.007）。
虽然抑郁发作后降糖药物的总体依从性较低，但抗抑郁治疗与依从性差的可能性较低相关。
