Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Diabetes Foundation (India), and National Diabetes Obesity and Cholesterol Foundation (NDOC), New Delhi, India.
J Diabetes. 2024 Mar;16(3):e13547. doi: 10.1111/1753-0407.13547.
To assess the association between glucagon-like peptide-1 receptor agonists (GLP-1RA) treatment and the risk of suicide attempts in people with type 2 diabetes (T2D), with a focus on subgroups with and without a history of depression or suicide attempts.
This retrospective cohort study utilized TriNetX, a federated network of real-world data. Using the Global Collaborative Network data, we collected electronic medical records from 113 health care organizations with 135 million patient records with 8 million with T2D, 83% from the United States. The four cohorts were identified based on age, medication, diagnosis, and presence of depression or suicide attempts. Analytic methods included measures of association and number of Instances, with propensity score matching employed to mitigate potential confounders. The primary outcome was the incidence of suicide attempts among people with T2D with GLP-1RA treatment in comparison with dipeptidyl peptidase-4 inhibitor (DPP-4i) treatment.
People with T2D treated with GLP-1RA consistently exhibited a lower risk of suicide attempts compared to those treated with DPP-4i. This was particularly significant in people with a history of depression or suicide attempts. The risk and odds ratios were significantly lower in the GLP-1RA-treated cohorts than in DPP-4i across all analyses.
As compared with DPP-4i, our analysis shows a protective effect associated with GLP-1RA treatment on the risk of suicide attempts among people with T2D. However, further research, particularly prospective and randomized studies, is necessary to confirm these observations and understand the underlying mechanisms.
评估胰高血糖素样肽-1 受体激动剂 (GLP-1RA) 治疗与 2 型糖尿病 (T2D) 患者自杀企图风险之间的关联，重点关注有或无抑郁或自杀企图史的亚组。
本回顾性队列研究利用了 TriNetX，这是一个真实世界数据的联邦网络。使用全球合作网络数据，我们从 113 家医疗保健组织收集了 1.35 亿份电子病历，其中 800 万份来自美国的 T2D 患者。四个队列是根据年龄、药物、诊断以及是否存在抑郁或自杀企图来确定的。分析方法包括关联测量和实例数，使用倾向评分匹配来减轻潜在的混杂因素。主要结局是与接受二肽基肽酶-4 抑制剂 (DPP-4i) 治疗相比，接受 GLP-1RA 治疗的 T2D 患者自杀企图的发生率。
与接受 DPP-4i 治疗的患者相比，接受 GLP-1RA 治疗的 T2D 患者自杀企图的风险始终较低。在有抑郁或自杀企图史的患者中，这种情况更为显著。在所有分析中，GLP-1RA 治疗组的风险和优势比均显著低于 DPP-4i 治疗组。
与 DPP-4i 相比，我们的分析显示，GLP-1RA 治疗与 T2D 患者自杀企图风险降低相关。然而，需要进一步的研究，特别是前瞻性和随机研究，以确认这些观察结果并了解潜在机制。
