medwireNews: The risk for macrovascular complications and mortality in people with diabetes and depression may be less for those who consistently take their antidepressant medications, research suggests.
The results come from data for 36,276 people (61.8% women), identified in Taiwan’s national health insurance database, who had just started taking their first antidiabetes medication and also had a diagnosis of depression.
All participants were free of micro- and macrovascular diabetes complications at baseline, but many had risk factors such as hypertension (41.8%) and dyslipidemia (37.5%). During follow-up lasting an average of 5.3 years, 6837 participants developed microvascular complications, 9670 had macrovascular complications, and 3820 died.
The researchers found that regular antidepressant use (filling prescriptions to cover ≥80% of the assessed period) was associated with a significant 8% reduction in risk for macrovascular outcomes and a 14% reduction in mortality risk, compared with poor use (<50%).
Yi-Jiun Pan (China Medical University, Taichung, Taiwan) and colleagues say this finding “could not be fully explained by the ‘healthy adherer effect,’” whereby consistent medication-taking is a marker of overall healthy behavior.
They note that the findings were adjusted for consistency of diabetes medication-taking, in addition to other factors including age, sex, comorbidities, and use of other medications.
Furthermore, the team did the same analysis with benzodiazepines as a negative control, and found that the regularity of use of these medications was not related to the risk for diabetes complications.
Partial use (50–80%) of antidepressants did not influence risk for diabetes complications, relative to poor use, but no use was associated with a reduced risk for macrovascular outcomes and mortality, of 9% and 18%, respectively.
The team suggests this is because people with no use may have had mild depression, treated with non-pharmacologic options.
“Of note, we found the diabetic medication adherence was lower than that of previous studies, based on patients with diabetes,” write Pan and colleagues in The Journal of Clinical Endocrinology & Metabolism.
“We considered patients with diabetes with depressive disorders might have poorer drug adherence than those without depressive disorders.”
The researchers caution that they were not able to account for factors including BMI and glycated hemoglobin level, but nonetheless conclude that “clinicians should emphasize antidepressant treatment adherence among patients with depression and diabetes.”
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J Clin Endocrinol Metab 2021; 10.1210/clinem/dgab443