Diabetes and Poor Disease Control: Is Comorbid Depression Associated With Poor Medication Adherence or Lack of Treatment Intensification?
Diabetes and Poor Disease Control: Is Comorbid Depression Associated With Poor Medication Adherence or Lack of Treatment Intensification?
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DOI：
10.1097/psy.0b013e3181bd8f55
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发表时间：
2009-11-01
影响因子：
3.3
通讯作者：
Von Korff, Michael
中科院分区：
文献类型：
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作者：
Katon, Wayne;Russo, Joan;Von Korff, Michael
目的：假设患有抑郁症和糖尿病且疾病控制不佳的患者对疾病控制药物的依从性较差，并且医生强化治疗的可能性较小。许多糖尿病患者未能达到美国糖尿病协会的血糖、血压和血脂控制指南。抑郁症是一种常见的合并症，可能通过对依从性和医生强化治疗的不利影响来影响疾病控制。方法：在 4117 名糖尿病患者的队列中，使用患者健康问卷 9 (PHQ-9) 测量基线抑郁程度。在这 5 年期间，对有证据表明疾病控制不佳（HbA(1c) >= 8.0%、LDL >= 130 mg/dL、收缩压 >= 140 mm Hg）的患者进行了患者依从性和医生强化治疗的评估。依从性差的定义是，在针对每种情况开出的药物所涵盖的天数中，药物补充间隙≥20%。治疗强化的定义是在达到上述目标水平之前和之后的 3 个月内增加某一类别的药物剂量、增加药物类别的数量或切换到不同的类别。结果：在疾病控制不佳的糖尿病患者中，抑郁症与糖尿病控制药物（比值比 [OR] = 1.98；95% 置信区间 [CI] = 1.31, 2.98）、抗高血压药物（OR = 2.06；95% CI = 1.47, 2.88）和 LDL 控制药物（OR = 2.43；95% CI = 1.47, 2.88）依从性较差的可能性增加相关。 95% CI = 1.19, 4.97）。在疾病控制不佳且坚持用药或尚未开始用药的患者中，抑郁症与医生强化治疗的可能性差异无关。结论：在疾病控制不佳的糖尿病患者中，抑郁是患者服药依从性差的重要危险因素，但并非缺乏医生强化治疗的危险因素。
Objective: To hypothesize that patients with comorbid depression and diabetes and poor disease control will have poorer adherence to disease control medication and less likelihood of physician intensification of treatment. Many patients with diabetes fail to achieve American Diabetes Association Guidelines for glycemic, blood pressure and lipid control. Depression is a common comorbidity and may affect disease control through adverse effects on adherence and physician intensification of treatment. Methods: In a cohort of 4117 patients with diabetes, depression was measured at baseline with the Patient Health Questionnaire-9 (PHQ-9). Patient adherence and physician intensification of treatment were measured in those who had evidence of poor disease control (HbA(1c) >= 8.0%, LDL >= 130 mg/dL, systolic blood pressure >= 140 mm Hg) over this 5-year period. Poor adherence was defined as having medication refill gaps for >= 20% of days covered for medications prescribed for each of these conditions. Treatment intensification was defined as an increased medication dosage in a class, an increase in the number of medication classes, or a switch to a different class within 3-month periods before and after notation of above target levels. Results: Among patients with diabetes and poor disease control, depression was associated with an increased likelihood of poor adherence to diabetes control medications (odds ratio [OR] = 1.98; 95% Confidence Interval [CI] = 1.31, 2.98), antihypertensives (OR = 2.06; 95% CI = 1.47, 2.88), and LDL control medications (OR = 2.43; 95% CI = 1.19, 4.97). In patients with poor disease control who were adherent to medication or not yet started on a medication, depression was not associated with differences in likelihood of physician intensification of treatment. Conclusions: In patients with diabetes and poor disease control, depression is an important risk factor for poor patient adherence to medications, but not lack of treatment intensification by physicians.