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Association Between Antidepressant Use and Adherence to Antihyperglycemic Medications in Adults With Type 2 Diabetes and Depression: A Retrospective Cohort Study

  • Diva Niaz
    Affiliations
    Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
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  • Candace Necyk
    Correspondence
    Address for correspondence: Candace Necyk BSc(Pharm), MSc, PhD, and Scot H. Simpson BSP, PharmD, MSc, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 3-25 Medical Sciences Building, Edmonton, Alberta T6G 2H7, Canada.
    Affiliations
    Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
    Search for articles by this author
  • Scot H. Simpson
    Correspondence
    Address for correspondence: Candace Necyk BSc(Pharm), MSc, PhD, and Scot H. Simpson BSP, PharmD, MSc, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 3-25 Medical Sciences Building, Edmonton, Alberta T6G 2H7, Canada.
    Affiliations
    Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada

    Alberta Diabetes Institute, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, Alberta, Canada
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Published:April 11, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.03.002

      Abstract

      Objectives

      Depression is a known risk factor for poor medication adherence, but it is unclear whether depression treatment affects adherence rates. In this study, we examined the association between pharmacologic treatment of a new depressive episode and subsequent adherence to oral antihyperglycemic medications.

      Methods

      In this retrospective cohort study, we used administrative health data to follow adult new metformin users in Alberta, Canada, between 2008 and 2018. Depressive episodes starting ≥1 year after metformin initiation were identified and individuals starting antidepressant treatment within the first 90 days were compared with those who did not. The proportion of days covered (PDC) with oral antihyperglycemic medications in the subsequent year (days 91 to 455) was used to estimate adherence. The association between antidepressant treatment and poor adherence (PDC<0.8) was examined using multivariate logistic regression models.

      Results

      A new depressive episode occurred in 6,201 people, with a mean age of 56.0 (standard deviation [SD], 15.4) years. Of this cohort, 3,303 (53.2%) were women. Mean PDC was 0.55 (SD, 0.41); 924 (57.0%) of 1,621 people who started antidepressant treatment and 2,709 (59.2%) of 4,580 controls had poor adherence (p=0.13). After adjusting for baseline comorbidities and other characteristics, antidepressant treatment was associated with a lower likelihood of poor adherence (adjusted odds ratio, 0.85; 95% confidence interval, 0.75 to 0.96; p=0.007).

      Conclusions

      Although overall adherence to antihyperglycemic medications was low after onset of a depressive episode, antidepressant treatment was associated with a lower likelihood of poor adherence.

      Résumé

      Objectifs

      La dépression est un facteur de risque connu de la mauvaise observance du traitement médicamenteux, mais on ignore si le traitement de la dépression nuit aux taux d’observance. Dans la présente étude, nous avons examiné l’association entre le traitement pharmacologique d’un nouvel épisode dépressif et l’observance subséquente aux médicaments antihyperglycémiants par voie orale.

      Méthodes

      Dans cette étude de cohorte rétrospective, nous avons utilisé les données administratives sur la santé pour suivre les nouveaux utilisateurs adultes de metformine en Alberta, au Canada, entre 2008 et 2018. Nous avons recensé les épisodes dépressifs qui avaient commencé ≥ 1 an après l’amorce de la metformine et avons comparé les individus qui avaient commencé le traitement antidépresseur au cours des 90 premiers jours à ceux qui ne l’avaient pas commencé. Nous avons utilisé la proportion de jours couverts (PJC) par les médicaments antidépresseurs dans l’année subséquente (jours 91 à 455) pour estimer l’observance. Nous avons examiné l’association entre le traitement antidépresseur et la mauvaise observance (PJC < 0,8) à l’aide de modèles de régression logistique multivariée.

      Résultats

      Un nouvel épisode dépressif était survenu chez 6201 personnes, d’âge moyen de 56,0 (écart type [σ], 15,4) ans. Cette cohorte avait regroupé 3303 (53,2 %) femmes. La PJC moyenne était de 0,55 (σ, 0,41); 924 (57,0 %) personnes sur 1621 avaient commencé le traitement antidépresseur et 2709 (59,2 %) témoins sur 4580 avaient eu une mauvaise observance (p = 0,13). Après l’ajustement des maladies associées initiales et d’autres caractéristiques, le traitement antidépresseur a été associé à une probabilité plus faible de mauvaise observance (rapport de cotes ajusté, 0,85; intervalle de confiance à 95 %, de 0,75 à 0,96; p = 0,007).

      Conclusions

      Bien que l’observance globale du traitement antihyperglycémiant ait été faible après l’apparition de l’épisode dépressif, le traitement antidépresseur a été associé à une probabilité plus faible de mauvaise adhésion.

      Keywords

      Mots clés

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