The impact of incident depression on medication adherence in patients with type 2 diabetes
The impact of incident depression on medication adherence in patients with type 2 diabetes
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DOI：
10.1016/j.diabet.2017.07.003
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发表时间：
2017-12-01
影响因子：
7.2
通讯作者：
Guenette, L.
中科院分区：
文献类型：
--
作者：
Lunghi, C.;Zongo, A.;Guenette, L.
背景资料。-抑郁与对抗糖尿病药物(ADS)的依从性不佳有关。大多数关于这一主题的研究都是横断面的；因此，这种关系的方向性无法确定。这项研究的目的是在新接受治疗的糖尿病患者中衡量抑郁发生率与AD不依从性之间的关系。-我们使用魁北克公共医疗保险数据在新的AD使用者中进行了一项基于人群的队列研究。为了避免永恒的时间偏差，我们通过为没有抑郁的个体指定一个抑郁诊断的日期来进行抑郁诊断-时间分布匹配。结果是在抑郁症诊断后的一年内(真实或指定日期)没有坚持(即，>；1 AD覆盖90%的天数)。经基线依从性和其他混杂因素调整后的多变量Logistic回归分析用于评估抑郁对AD非依从性的调整效果。-在2000至2006年间，我们确定了3,106名随后被诊断为抑郁症的新AD使用者和70,633名未患抑郁症的AD使用者，其中分别有52%和49%的人不遵守AD治疗。在抑郁症患者中，52.0%的患者在抑郁症确诊后的一年内被认为是AD非粘附者，而匹配的非抑郁症患者的这一比例为49.0%。在考虑了基线依从性和其他混杂因素后，抑郁症与AD不依从性相关，调整后的优势比为1.24(95%可信区间：1.13-1.37)。-结果表明，抑郁是AD不依从性的独立危险因素。2型糖尿病和抑郁症患者可能会从依从性增强的干预中受益。(C)2017年爱思唯尔·马森公司。版权所有。
Background. - Depression has been correlated with suboptimal adherence to antidiabetic drugs (ADs). Most studies on this topic were cross-sectional; thus, the directionality of this relationship could not be established. The objective of this study was to measure the association between incident depression and AD nonadherence among newly treated patients with diabetes.Methods. - We performed a population-based cohort study among new AD users using the Quebec public health insurance data. To avoid immortal time bias, we carried out depression diagnosis-time distribution matching by assigning a date of depression diagnosis to individuals without depression. Nonadherence (i.e., < 90% of days covered by > 1 AD) during the year following depression diagnosis (real or assigned date) was the outcome. Multivariate logistic regression analyses that adjusted for baseline adherence and other confounders were used to estimate the adjusted effect of depression on AD nonadherence.Results. - Between 2000 and 2006, we identified 3,106 new AD users with a subsequent diagnosis of depression and 70,633 without depression, of which 52% and 49% became non-adherent to AD treatment, respectively. Among patients with depression, 52.0% were considered AD non-adherent in the year after depression diagnosis compared with 49.0% of matched patients without depression. Depression was associated with AD nonadherence after accounting for baseline adherence and other confounders with an adjusted odds ratio of 1.24 (95% confidence interval: 1.13-1.37).Conclusions. - The results suggest that depression is an independent risk factor for AD nonadherence. Patients with type 2 diabetes and depression might benefit from adherence-enhancing interventions. (C) 2017 Elsevier Masson SAS. All rights reserved.