The association between antidepressant use and hypoglycaemia in diabetic patients: a nested case-control study

被引:27
作者
Derijks, Hieronymus J. [1 ,2 ]
Heerdink, Eibert R. [1 ]
De Koning, Fred H. [1 ,3 ]
Janknegt, Robert [2 ]
Klungel, Olaf H. [1 ]
Egberts, Antoine C. [1 ,4 ]
机构
[1] Univ Utrecht, Fac Sci, Utrecht Inst Pharmaceut Sci, Div Pharmacoepidemiol & Pharmacotherapy, NL-3508 TB Utrecht, Netherlands
[2] Orbis Med Ctr, Dept Clin Pharm, Sittard, Netherlands
[3] Assoc Kring Apotheken Netherlands, Den Bosch, Netherlands
[4] Univ Med Ctr Utrecht, Dept Clin Pharm, NL-3508 TB Utrecht, Netherlands
关键词
antidepressive agents; diabetes mellitus; hypoglycaemia; adverse drug reactions; drug safety;
D O I
10.1002/pds.1562
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Purpose Hypoglycaemia is a limiting factor for glycaemic management of diabetes with intensive insulin and/or oral antidiabetic drug (OAD) regimen. Case reports suggest that antidepressants may interfere with blood glucose metabolism in patients with diabetes mellitus potentially increasing the risk of clinically relevant hypoglycaemia. Comorbid depression treated with antidepressants could therefore further complicate glycaemic control. We have carried out a nested case-control study among diabetic patients to assess the risk of hypoglycaemia requiring hospitalisation associated with the use of antidepressants. Methods Diabetic patients treated with insulin and/or OADs were selected from the Dutch Pharmo system. Exposure to antidepressants was the primary determinant investigated. Use of antidepressants was further subclassified based on the receptor binding profile to investigate whether specific pharmacological properties could explain a potential influence on glucose homeostasis. Conditional logistic regression was used to estimate odds ratios and to adjust for confounding factors. Results From the base cohort (40 600 patients), 549 (1.35%) cases were identified and 1897 controls were selected. Current use of any antidepressant was not associated with a significantly higher risk of hypoglycaemia requiring hospitalisation (OR: 1.36 (95%CI: 0.84-2.20)). A trend for a higher risk on hypoglycaemia was identified for antidepressants with high affinity for the serotonin reuptake transporter. The risk on severe hypoglycaemia was increased after 3 years of use (OR: 2.75 (95%CI: 1.31-5.77)). Conclusions It is important for diabetic patients using antidepressants for more than 3 years to pay attention for symptoms of hypoglycaemia and strict blood glucose self-monitoring. Copyright (c) 2008 John Wiley & Sons, Ltd.
引用
收藏
页码:336 / 344
页数:9
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