PDS：抗抑郁药降低糖尿病人服药依从性

　　一项回顾性研究显示抑郁可能与糖尿病患者服药依从性差有关，合并抑郁症的糖尿病患者需要更多合理用药指导。研究于2013年2月28日在线发表在《药物流行病学和药品安全》杂志。

　　研究旨在观察抗抑郁药是否会对老年人坚持服用口服降糖药产生影响。研究者收集来自澳大利亚退伍军人事务部的数据，即2000年7月1日到2008年6月30日期间开始口服降糖药（二甲双胍或磺脲类药物）的患者。抗抑郁药在首次服用降糖药的六个月内开始使用。研究者比较了服用和未服用抗抑郁药的患者中断糖尿病治疗的时间。对变量进行校正后，使用竞争风险回归分析。

　　研究共纳入29710名开始服用二甲双胍或磺脲类药物的患者，其中7171人（24.2%）服用抗抑郁药。同时服用抗抑郁药的患者坚持口服降糖药的时间（中位数）为1.81年（95%可信区间1.72-1.94），而未服用抗抑郁药的患者则为3.23年（95%可信区间3.10-3.40）。竞争风险分析显示同时使用抗抑郁药的患者中断服用降糖药的可能性比未用抗抑郁药者高出42%（危险比1.42，95%可信区间1.37-1.47，P<0.001）。

Does antidepressant medication use affect persistence with diabetes medicines?

Purpose

This study aimed to examine the effect of antidepressant use on persistence with newly initiated oral antidiabetic medicines in older people.

Methods

A retrospective study of administrative claims data from the Australian Government Department of Veterans' Affairs, from 1 July 2000 to 30 June 2008 of new users of oral antidiabetic medicines (metformin or sulfonylurea). Antidepressant medicine use was determined in the 6 months preceding the index date of the first dispensing of an oral antidiabetic medicine. The outcome was time to discontinuation of diabetes therapy in those with antidepressant use compared with those without. Competing risks regression analyses were conducted with adjustment for covariates.

Results

A total of 29 710 new users of metformin or sulfonylurea were identified, with 7171 (24.2%) dispensed an antidepressant. Median duration of oral antidiabetic medicines was 1.81 years (95% CI 1.72–1.94) for those who received an antidepressant at the time of diabetes medicine initiation, by comparison to 3.23 years (95% CI 3.10–3.40) for those who did not receive an antidepressant. Competing risk analyses showed a 42% increased likelihood of discontinuation of diabetes medications in persons who received an antidepressant (subdistribution hazard ratio 1.42, 95% CI 1.37–1.47, p < 0.001).

Conclusions

The results of this large population-based study demonstrate that depression may be contributing to non-compliance with medicines for diabetes and highlight the need to provide additional services to support appropriate medicine use in those initiating diabetes medicines with co-morbid depression. Copyright © 2013 John Wiley & Sons, Ltd.