Second Generation Antipsychotics on Diabetes Outcomes in Major Depression

项目摘要/摘要 NIMH F31奖将支持我在使用大型、复杂的药物流行病学研究方面的培训 观测数据库。我的长期目标是进行研究，帮助选择 药物治疗，以改善那些患有精神和身体疾病的患者的预后。 我得到了一个在药物流行病学方面有专长的多学科合作研究团队的支持 方法，多种疾病，糖尿病和心理健康，非常适合提供指导，以实现我的 培训目标。与我的长期目标相一致，我的论文研究将评估第二个 世代抗精神病药物(SGAs)对重度抑郁症患者糖尿病预后的影响 疾病(MDD)和既往存在的II型糖尿病(T2 DM)。 SGAS最近已成为一种更广泛接受的MDD治疗选择。根据《国家新闻周刊》 2009-2010年门诊医疗护理调查，12.5%的成年人非精神病，单相抑郁办公室 访问导致了SGA处方，自1999-2000年以来几乎增加了三倍。此外， 上升幅度最大的是合并糖尿病、血脂异常或心血管疾病的患者。 疾病。众所周知，SGA与患糖尿病的风险增加有关；然而，他们的 抑郁症和既往糖尿病患者对糖尿病预后的影响不好 明白了。使用SGAS与以下人群中低血糖和高血糖的风险增加有关 65岁及以上既有糖尿病患者。相比之下，精神分裂症或躁郁症患者的研究 65岁以下的精神障碍患者得出结论，使用SGA与改善糖尿病有关 结果。考虑到抑郁症和糖尿病经常同时发生，两种疾病的患者都在 全因和心血管死亡率的高风险，了解SGAs对糖尿病的影响 结果对患者、临床医生和公共卫生都有很大影响。 具体目的是比较SGAS的患者特征、临床病史和治疗模式。 成年抑郁症患者与替代二线抑郁症药物的比较--18- 合并T2 DM(目标1)；检查SGA的使用与替代二线抑郁症的影响 药物治疗对糖尿病相关住院或糖尿病治疗强化风险的影响 (目标2)；并评价阿立哌唑、奎硫平、安非他酮、米氮平和三环的比较效果 糖尿病相关住院或糖尿病治疗强化的抗抑郁药(TCAs) MDD合并糖尿病患者(目标3)。此外，我们将比较全队列的性能 识别时与特定于子组的高维倾向分数(HDPS)匹配算法 本研究背景下的暴露分组(次级目标3a)。

Project Summary/Abstract The NIMH F31 award will support my training in pharmacoepidemiologic research using large, complex observational databases. My long-term goal is to conduct research that helps inform the selection of pharmacologic treatments to enhance patient outcomes among those with mental and physical illness. I have the support of a multidisciplinary collaborative research team with expertise in pharmacoepidemiologic methods, multi-morbidity, diabetes, and mental health, well-suited to provide mentorship in achieving my training goals. Aligned with my long-term goal, my dissertation research will evaluate the impact of second generation antipsychotics (SGAs) on diabetes outcomes among patients with major depressive disorder (MDD) and pre-existing type II diabetes (T2DM). SGAs have recently become a more widely accepted treatment option for MDD. According to the National Ambulatory Medical Care Survey 2009-2010, 12.5% of adult non-psychotic, unipolar depression office visits resulted in a SGA prescription, an almost three-fold increase since 1999-2000. Moreover, the largest increases were among patients with comorbid diabetes, dyslipidemia, or cardiovascular disease. It is well-known that SGAs are associated with increased risk of developing diabetes; however, their impact on diabetes outcomes among patients with depression and pre-existing diabetes is not well understood. Use of SGAs is associated with increased risk of both hypoglycemia and hyperglycemia among patients 65 years and older with pre-existing diabetes. In contrast, studies among schizophrenia or bipolar disorder patients younger than 65 years have concluded that SGA use is associated with improved diabetes outcomes. Given that depression and diabetes frequently co-occur and patients with both disorders are at higher risk for all-cause and cardiovascular mortality, understanding the influence of SGAs on diabetes outcomes is highly consequential for patients, clinicians, and public health. The specific aims are to compare patient characteristics, clinical history, and treatment patterns of SGAs versus alternative second-line depression medications among adult patients 18-64 years with MDD and comorbid T2DM (Aim 1); examine the impact of SGA use compared to alternative second-line depression medications on risk of diabetes-related hospitalization or diabetes treatment intensification in this population (Aim 2); and evaluate the comparative effect of aripiprazole, quetiapine, bupropion, mirtazapine, and tricyclic antidepressants (TCAs) on time to diabetes-related hospitalization or diabetes treatment intensification among patients with MDD and comorbid diabetes (Aim 3). Additionally, we will compare the performance of full-cohort vs. subgroup-specific high dimensional propensity score (hdPS) matching algorithms when identifying exposure subgroups in the context of this study (Sub-Aim 3a).