Purchase of antidepressant agents by patients with type 1 diabetes is associated with increased mortality rates in women but not in men
Purchase of antidepressant agents by patients with type 1 diabetes is associated with increased mortality rates in women but not in men
复制标题
DOI：
10.1007/s00125-011-2347-6
复制
发表时间：
2012-01-01
期刊：
影响因子：
8.2
通讯作者：
Groop, P. -H.
中科院分区：
文献类型：
--
作者：
Ahola, A. J.;Harjutsalo, V.;Groop, P. -H.
与一般人群相比，糖尿病患者的死亡率更高。在2型糖尿病患者中，抑郁进一步增加了死亡率。1型糖尿病患者的抑郁和死亡率是一个未被充分研究的现象。因此，我们在前瞻性环境中研究了它们的关联。我们在芬兰糖尿病肾病研究（FinnDiane）中对4174名参与者（51%为男性，年龄39 +/- 12岁，糖尿病病程22 +/- 12年[平均+/- SD]）进行了平均9年的随访。抑郁症定义为在基线和随访期间购买抗抑郁药物。这些数据来自芬兰药物处方登记册。全因死亡率和死因数据来自芬兰死亡原因登记册。在基线时，313例（7.5%）患者购买了抗抑郁药物。随访期间新增758例（18.2%）。基线时购买抗抑郁药物的患者10年累积死亡率最高（22.5% [95% CI 18.1, 26.6]），其次是随访期间购买抗抑郁药物的患者（18.0%[15.4,20.5]）和未购买抗抑郁药物的患者（10.1% [9.0,11.2],p < 0.001）。在调整后的Cox回归模型（年龄、糖尿病病程、舒张压、吸烟、HbA（1c）和肾病）中，基线时购买抗抑郁药物与女性死亡率相关，但与男性无关。心血管疾病是非抗抑郁药物购买者死亡的主要原因。在抗抑郁药购买者中，慢性糖尿病并发症是最常见的潜在死亡原因。在1型糖尿病患者人群中，购买抗抑郁药物与女性死亡率增加有关，但与男性无关。
Individuals with diabetes have increased mortality rates compared with the general population. In patients with type 2 diabetes depression further contributes to the increased mortality. Depression and mortality rates in patients with type 1 diabetes are an understudied phenomenon. We therefore studied their association in a prospective setting.We followed 4,174 participants (51% men, age 39 +/- 12 years, diabetes duration 22 +/- 12 years [mean +/- SD]) in the Finnish Diabetic Nephropathy Study (FinnDiane) for an average of 9 years. Depression was defined as purchase of antidepressant agents at baseline and during follow-up. These data were obtained from the Finnish Drug Prescription Register. Data on all-cause mortality and cause of death were obtained from the Finnish Cause of Death Register.At baseline, 313 (7.5%) patients had purchased antidepressant agents. During follow-up 758 (18.2%) additional cases were observed. Purchasers of antidepressant agents at baseline had the highest 10-year cumulative mortality rate (22.5% [95% CI 18.1, 26.6]), followed by those with such purchases during follow-up (18.0% [15.4, 20.5]) and those with no purchases (10.1% [9.0, 11.2], p < 0.001). In the adjusted Cox regression models (age, diabetes duration, diastolic blood pressure, smoking, HbA(1c) and nephropathy), the purchase of antidepressant agents at baseline was associated with mortality in women, but not in men. Cardiovascular diseases were the major cause of death in non-purchasers of antidepressant agents. In antidepressant purchasers, chronic diabetic complications were the most frequent underlying cause of death.In a population of patients with type 1 diabetes, purchase of antidepressant agents was associated with increased mortality rates in women, but not in men.