Abstract：
OBJECTIVE: Depression in patients with diabetes mellitus is common and associated with poorer outcomes. This study aims to identify demographic, socioeconomic and medical factors associated with the initiation of antidepressant medication after a diagnosis of diabetes in adult patients without a previous prescription for antidepressants. We also examined frequency of primary care visits in the year after antidepressant initiation compared with the year before treatment began.
METHODS: This was a retrospective cohort study using routinely collected electronic medical record data spanning January 2011 to December 2019 from the University of Toronto Practice-based Research Network (UTOPIAN) Data Safe Haven. Our primary outcome was a first prescription for an antidepressant in patients with diabetes. We used a mixed-effects logistic regression model to identify sociodemographic and medical factors associated with this event.
RESULTS: Among 22,750 patients with diabetes mellitus, 3,055 patients (13.4%) began taking an antidepressant medication. Increased odds of antidepressant initiation were observed in younger patients (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.39 to 2.26), females (OR, 1.60; 95% CI, 1.46 to 1.7), those receiving insulin treatment (OR, 1.59; 95% CI, 1.43 to 1.78) and cases of polypharmacy (OR, 3.67; 95% CI, 3.29 to 4.11). There was an increase in the mean number of primary care visits from 4.6 to 5.9 per year after antidepressant initiation.
CONCLUSIONS: In patients with diabetes, age, sex and medical characteristics were associated with the initiation of antidepressants. These patients accessed primary care more frequently. Screening and prevention of depression, particularly in these subgroups, could reduce its personal and systemic burdens.
METHODS: This was a retrospective cohort study using routinely collected electronic medical record data spanning January 2011 to December 2019 from the University of Toronto Practice-based Research Network (UTOPIAN) Data Safe Haven. Our primary outcome was a first prescription for an antidepressant in patients with diabetes. We used a mixed-effects logistic regression model to identify sociodemographic and medical factors associated with this event.
RESULTS: Among 22,750 patients with diabetes mellitus, 3,055 patients (13.4%) began taking an antidepressant medication. Increased odds of antidepressant initiation were observed in younger patients (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.39 to 2.26), females (OR, 1.60; 95% CI, 1.46 to 1.7), those receiving insulin treatment (OR, 1.59; 95% CI, 1.43 to 1.78) and cases of polypharmacy (OR, 3.67; 95% CI, 3.29 to 4.11). There was an increase in the mean number of primary care visits from 4.6 to 5.9 per year after antidepressant initiation.
CONCLUSIONS: In patients with diabetes, age, sex and medical characteristics were associated with the initiation of antidepressants. These patients accessed primary care more frequently. Screening and prevention of depression, particularly in these subgroups, could reduce its personal and systemic burdens.
摘要：
目的：糖尿病患者的抑郁症是常见的，并且与较差的预后相关。这项研究旨在确定人口统计学，在没有抗抑郁药处方的成年患者中，与糖尿病诊断后开始抗抑郁药物治疗相关的社会经济和医学因素。我们还检查了抗抑郁药开始后一年与治疗开始前一年相比的初级保健就诊频率。
方法：这是一项回顾性队列研究，使用2011年1月至2019年12月从多伦多大学实践研究网络(UTOPIAN)数据安全港常规收集的电子病历数据。我们的主要结果是糖尿病患者的抗抑郁药的第一个处方。我们使用混合效应逻辑回归模型来确定与此事件相关的社会人口统计学和医学因素。
结果：在22,750名糖尿病患者中，3,055名患者（13.4％）开始服用抗抑郁药。在年轻患者中观察到抗抑郁药开始的几率增加(比值比[OR]，1.77；95%置信区间[CI]，1.39to2.26),女性（或，1.60；95%CI，1.46至1.7），那些接受胰岛素治疗的人(OR，1.59；95%CI，1.43至1.78)和多重用药病例(OR，3.67；95%CI，3.29至4.11）。抗抑郁药开始后，初级保健就诊的平均次数从每年4.6增加到5.9。
结论：在糖尿病患者中，年龄,性别和医学特征与开始服用抗抑郁药相关.这些患者获得初级保健的频率更高。筛查和预防抑郁症，特别是在这些亚组中，可以减轻其个人和系统负担。
方法：这是一项回顾性队列研究，使用2011年1月至2019年12月从多伦多大学实践研究网络(UTOPIAN)数据安全港常规收集的电子病历数据。我们的主要结果是糖尿病患者的抗抑郁药的第一个处方。我们使用混合效应逻辑回归模型来确定与此事件相关的社会人口统计学和医学因素。
结果：在22,750名糖尿病患者中，3,055名患者（13.4％）开始服用抗抑郁药。在年轻患者中观察到抗抑郁药开始的几率增加(比值比[OR]，1.77；95%置信区间[CI]，1.39to2.26),女性（或，1.60；95%CI，1.46至1.7），那些接受胰岛素治疗的人(OR，1.59；95%CI，1.43至1.78)和多重用药病例(OR，3.67；95%CI，3.29至4.11）。抗抑郁药开始后，初级保健就诊的平均次数从每年4.6增加到5.9。
结论：在糖尿病患者中，年龄,性别和医学特征与开始服用抗抑郁药相关.这些患者获得初级保健的频率更高。筛查和预防抑郁症，特别是在这些亚组中，可以减轻其个人和系统负担。
