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Factors Associated With Initiation of Antidepressant Medication in Adults With Type 1 and Type 2 Diabetes: A Primary Care Retrospective Cohort Study in Ontario, Canada

      Abstract

      Objectives

      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.

      Résumé

      Objectifs

      La dépression est fréquente et associée à de mauvais résultats cliniques chez les patients atteints du diabète sucré. La présente étude vise à déterminer les facteurs démographiques, socioéconomiques et médicaux associés à l’amorce des médicaments antidépresseurs après un diagnostic de diabète chez les patients adultes sans ordonnances antérieures d’antidépresseurs. Nous avons aussi examiné la fréquence des consultations en soins primaires dans l’année après l’amorce des antidépresseurs par rapport à l’année avant le début du traitement.

      Méthodes

      Il s’agissait d’une étude de cohorte rétrospective réalisée à partir de la collecte systématique des données de dossiers médicaux électroniques de janvier 2011 à décembre 2019 du University of Toronto Practice-Based Research Network (UTOPIAN) Data Safe Haven. Notre critère d’évaluation principal était la première ordonnance d’un antidépresseur chez les patients diabétiques. Nous avons utilisé un modèle de régression logistique à effets mixtes pour déterminer les facteurs sociodémographiques et médicaux associés à cet événement.

      Résultats

      Au sein des 22 750 patients atteints du diabète sucré, 3055 patients (13,4 %) commençaient à prendre les médicaments antidépresseurs. Nous avons observé une probabilité accrue d’amorcer les antidépresseurs chez les patients plus jeunes (rapport de cotes [RC], 1,77; intervalle de confiance [IC] à 95 %, de 1,39 à 2,26), les femmes (RC, 1,60; IC à 95 %, de 1,46 à 1,7), ceux qui recevaient une insulinothérapie (RC, 1,59; IC à 95 %, de 1,43 à 1,78) et les cas de polypharmacie (RC, 3,67; IC à 95 %, de 3,29 à 4,11). Il y a eu une augmentation du nombre moyen de consultations en soins primaires, soit de 4,6 à 5,9 par année après l’amorce des antidépresseurs.

      Conclusions

      Chez les patients diabétiques, l’âge, le sexe et les caractéristiques médicales étaient associés à l’amorce des antidépresseurs. Ces patients avaient plus fréquemment recours aux soins primaires. Le dépistage et la prévention de la dépression, particulièrement dans ces sous-groupes, pourraient contribuer à réduire leurs fardeaux personnels et systémiques.

      Keywords

      Mots clés

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