PDF(Pubmed)
Abstract：
OBJECTIVE: To assess the association between glucagon-like peptide-1 receptor agonists (GLP-1RA) treatment and the risk of suicide attempts in people with type 2 diabetes (T2D), with a focus on subgroups with and without a history of depression or suicide attempts.
METHODS: This retrospective cohort study utilized TriNetX, a federated network of real-world data. Using the Global Collaborative Network data, we collected electronic medical records from 113 health care organizations with 135 million patient records with 8 million with T2D, 83% from the United States. The four cohorts were identified based on age, medication, diagnosis, and presence of depression or suicide attempts. Analytic methods included measures of association and number of Instances, with propensity score matching employed to mitigate potential confounders. The primary outcome was the incidence of suicide attempts among people with T2D with GLP-1RA treatment in comparison with dipeptidyl peptidase-4 inhibitor (DPP-4i) treatment.
RESULTS: People with T2D treated with GLP-1RA consistently exhibited a lower risk of suicide attempts compared to those treated with DPP-4i. This was particularly significant in people with a history of depression or suicide attempts. The risk and odds ratios were significantly lower in the GLP-1RA-treated cohorts than in DPP-4i across all analyses.
CONCLUSIONS: As compared with DPP-4i, our analysis shows a protective effect associated with GLP-1RA treatment on the risk of suicide attempts among people with T2D. However, further research, particularly prospective and randomized studies, is necessary to confirm these observations and understand the underlying mechanisms.
METHODS: This retrospective cohort study utilized TriNetX, a federated network of real-world data. Using the Global Collaborative Network data, we collected electronic medical records from 113 health care organizations with 135 million patient records with 8 million with T2D, 83% from the United States. The four cohorts were identified based on age, medication, diagnosis, and presence of depression or suicide attempts. Analytic methods included measures of association and number of Instances, with propensity score matching employed to mitigate potential confounders. The primary outcome was the incidence of suicide attempts among people with T2D with GLP-1RA treatment in comparison with dipeptidyl peptidase-4 inhibitor (DPP-4i) treatment.
RESULTS: People with T2D treated with GLP-1RA consistently exhibited a lower risk of suicide attempts compared to those treated with DPP-4i. This was particularly significant in people with a history of depression or suicide attempts. The risk and odds ratios were significantly lower in the GLP-1RA-treated cohorts than in DPP-4i across all analyses.
CONCLUSIONS: As compared with DPP-4i, our analysis shows a protective effect associated with GLP-1RA treatment on the risk of suicide attempts among people with T2D. However, further research, particularly prospective and randomized studies, is necessary to confirm these observations and understand the underlying mechanisms.
摘要：
目的：评估胰高血糖素样肽-1受体激动剂（GLP-1RA）治疗与2型糖尿病（T2D）患者自杀未遂风险之间的关系，重点关注有和没有抑郁症或自杀未遂史的亚组。
方法：这项回顾性队列研究使用了TriNetX，现实世界数据的联合网络。使用全球协作网络数据，我们从113个医疗机构收集了电子医疗记录，其中有1.35亿条患者记录，其中有800万条T2D，83%来自美国。这四个队列是根据年龄确定的，药物,诊断,以及抑郁症或自杀未遂的存在。分析方法包括关联度量和实例数量，倾向得分匹配用于减轻潜在的混杂因素。主要结果是与二肽基肽酶-4抑制剂（DPP-4i）治疗相比，使用GLP-1RA治疗的T2D患者自杀企图的发生率。
结果：接受GLP-1RA治疗的T2D患者与接受DPP-4i治疗的患者相比，自杀企图的风险始终较低。这在有抑郁症或自杀未遂病史的人中尤其重要。在所有分析中，GLP-1RA治疗组的风险和比值比显著低于DPP-4i。
结论：与DPP-4i相比，我们的分析显示,GLP-1RA治疗对T2D患者自杀未遂风险有保护作用.然而,进一步研究,特别是前瞻性和随机研究，有必要确认这些观察结果并了解潜在的机制。
方法：这项回顾性队列研究使用了TriNetX，现实世界数据的联合网络。使用全球协作网络数据，我们从113个医疗机构收集了电子医疗记录，其中有1.35亿条患者记录，其中有800万条T2D，83%来自美国。这四个队列是根据年龄确定的，药物,诊断,以及抑郁症或自杀未遂的存在。分析方法包括关联度量和实例数量，倾向得分匹配用于减轻潜在的混杂因素。主要结果是与二肽基肽酶-4抑制剂（DPP-4i）治疗相比，使用GLP-1RA治疗的T2D患者自杀企图的发生率。
结果：接受GLP-1RA治疗的T2D患者与接受DPP-4i治疗的患者相比，自杀企图的风险始终较低。这在有抑郁症或自杀未遂病史的人中尤其重要。在所有分析中，GLP-1RA治疗组的风险和比值比显著低于DPP-4i。
结论：与DPP-4i相比，我们的分析显示,GLP-1RA治疗对T2D患者自杀未遂风险有保护作用.然而,进一步研究,特别是前瞻性和随机研究，有必要确认这些观察结果并了解潜在的机制。
