The impact of hospital-diagnosed depression or use of antidepressants on treatment initiation, adherence and HbA 1c /LDL
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ARTICLE
The impact of hospital-diagnosed depression or use of antidepressants on treatment initiation, adherence and HbA1c/LDL target achievement in newly diagnosed type 2 diabetes Christopher Rohde 1,2 & Jakob S. Knudsen 2,3 & Norbert Schmitz 4 & Søren Dinesen Østergaard 1,2 & Reimar W. Thomsen 2,3 Received: 15 June 2020 / Accepted: 2 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Aims/hypothesis We aimed to assess whether current antidepressant therapy or a history of hospital-diagnosed depression affects diabetes treatment initiation, adherence, and HbA1c and LDL-cholesterol target achievement. Methods In this register-based study, we included all individuals from Central and Northern Denmark with newly diagnosed type 2 diabetes, defined as a first-ever HbA1c measurement of ≥48 mmol/mol (6.5%), between 2000 and 2016. Individuals either diagnosed with depression at a psychiatric hospital in the 2 years prior to their diabetes diagnosis or currently receiving treatment with an antidepressant were compared with individuals with type 2 diabetes, but without depression treatment or previous history of depression. Outcome measures included initiation of glucose-lowering drugs and lipid-modifying agents, adherence to these medications (medication possession ratio >80%), and HbA1c (10.5%) [32]. We obtained information on comorbid conditions included in the Charlson comorbidity index (CCI) [33] prior
Diabetologia
to type 2 diabetes diagnosis from the DNPatR (not counting diabetes). We defined three categories of comorbidity based on CCI total scores of 0, 1 and 2. We obtained information on macro- and microvascular complications, hospital-diagnosed obesity, alcohol-related diagnoses and smoking-associated disorders (see the ICD-8/ICD-10 codes in ESM Table 1). LABKA was used to obtain baseline eGFR (calculated from age, sex and creatinine), total cholesterol and LDL-cholesterol levels.
Outcomes Time to GLD or lipid-modifying agent initiation We followed the cohort members from type 2 diabetes diagnosis until they initiated treatment (redeemed a prescription) with a GLD, died or emigrated, or until the end of follow-up (1 year after diabetes diagnosis), whichever came first. The same approach was used for initiation of treatment with a lipid-modifying agent. GLD and lipid-modifying agent adherence Among the individuals with type 2 diabetes that initiated a GLD and/or a lipid-modifying agent, we assessed the extent to which they were adherent to this treatment. Specifically, we followed them from the time of their first GLD and/or lipid-modifying agent prescription redemption and for 1 year onwards. We used the medication possession ratio (MPR) for this year, i.e. the time under treatment divided by 1 year, to assess adherence. The time under treatment was calculated via the following formula: (dose × number of pills per package/defined daily dosage [DDD]) × 1.15 + 7 days [34]. Good adherence was defined as an MPR >80% [35]. HbA1c and LDL-cholesterol treatment targets We defined H
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