抑郁症是2型糖尿病最常见的合并症之一。这两种疾病之间的关系似乎是双向的。这两种情况分别导致显著的发病率和死亡率,包括住院。此外,抑郁症与抗糖尿病药物的非持久性相关。
为了测量抑郁症对发病率的影响,特别是对所有原因的影响,糖尿病相关,心血管相关和主要心血管事件相关住院,调整非持久性抗糖尿病药物和其他混杂因素。
我们在一组开始服用抗糖尿病药物的2型糖尿病患者中进行了巢式病例对照研究。利用魁北克省的卫生行政数据,加拿大,我们确定了所有原因,糖尿病相关,在开始抗糖尿病药物治疗后的最长8年随访期间,心血管相关和主要心血管住院。密度抽样方法按年龄匹配所有病例与多达10个对照,性别,和Elixhauser合并症指数。抑郁症对住院的影响是使用条件逻辑回归来评估的,该回归针对抗糖尿病药物治疗的非持久性和其他变量进行了调整。
我们确定了41,550例全因住院病例,其中34,437例与心血管(CV)疾病有关,29,584糖尿病,和13867个重大CV事件。在2.51%的全因住院患者和1.16%的匹配对照组中诊断出抑郁症。69.11%的病例和72.59%的对照组使用二甲双胍单药治疗。大多数(71.62%对75.02%,分别)在随访期间继续使用二甲双胍单药治疗,未添加或转换药物。两组的非持久性发生率相似(约30%)。在多变量分析中,抑郁症与全因住院的风险增加有关,根据模型调整(从单变量到完全遵守),比值比(OR)范围为2.21(95%CI:2.07-2.37)至1.32(95%CI:1.22-1.44)。
抑郁症增加了糖尿病患者全因住院的风险,即使考虑到非持久性和其他潜在的混杂因素。这些结果强调了抑郁症对糖尿病患者使用医疗保健资源的影响。
Depression is one of the most common comorbidities of type 2 diabetes. The relationship between these two diseases seems to be bidirectional. Both conditions separately lead to significant morbidity and mortality, including hospitalization. Moreover, depression is associated with non-persistence with antidiabetic drugs.
To measure the effect of depression on morbidity and particularly on all-cause, diabetes-related, cardiovascular-related and major cardiovascular events-related hospitalization, adjusting for non-persistence to antidiabetic drugs and other confounders.
We performed a nested
case-control study within a cohort of type 2 diabetic individuals initiating antidiabetic drugs. Using the health administrative data of the province of Quebec, Canada, we identified all-cause, diabetes-related, cardiovascular-related and major cardiovascular hospitalizations during a maximum follow-up of eight years after the initiation of antidiabetic drug treatment. A density sampling method matched all cases with up to 10 controls by age, sex, and the Elixhauser comorbidity index. The effect of depression on hospitalization was estimated using conditional logistic regressions adjusting for non-persistence to antidiabetic drug treatment and other variables.
We identified 41,550 all-cause hospitalized cases, of which 34,437 were related to cardiovascular (CV) diseases, 29,584 to diabetes, and 13,867 to major CV events. Depression was diagnosed in 2.51% of all-cause hospitalizations and 1.16% of matched controls. 69.11% of cases and 72.59% of controls were on metformin monotherapy. The majority (71.62% vs 75.02%, respectively) stayed on metformin monotherapy without adding or switching drugs during follow-up. Non-persistence was at similar rates (about 30%) in both groups. In the multivariable analyses, depression was associated with an increased risk for all-cause hospitalizations, with odds ratios (ORs) ranging from 2.21 (95% CI: 2.07-2.37) to 1.32 (95% CI: 1.22-1.44) according to the model adjustment (from the univariate to the fully adhjusted).
Depression increased the risk of all-cause hospitalizations among patients treated for diabetes, even after accounting for non-persistence and other potentially confounding factors. These results stress the impact of depression on diabetic patients\' use of health care resources.