December 26, 2019
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Antidepressants reduce hyperglycemic crisis in diabetes with depressive disorder

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Yu-Chih Shen

Adults with diabetes and depressive disorder treated with antidepressant drugs experienced fewer episodes of hyperglycemic crisis than those not taking antidepressant medications, according to findings published in the Journal of Diabetes and its Complications.

“Hyperglycemic crisis episode includes diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome, both of which can be life-threatening if left untreated,” Yu-Chih Shen, MD, PhD, director of the department of psychiatry at Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and associate professor in department of human development at Tzu-Chi University School of Medicine in Taiwan, and colleagues wrote. “Even after hyperglycemic crisis episode, an even higher mortality risk observed during the follow-up period underscores the importance of preventing hyperglycemic crisis episodes to improve outcomes for patients.”

Shen and colleagues compared data from a cohort of 26,746 adults with diabetes and depressive disorder (60.8% aged 30-49 years; 57.5% women) with data from a matched cohort of 106,853 adults with diabetes but no depressive disorder (60.8% aged 30-49 years; 57.5% women). The National Health Insurance Research Database of Taiwan provided data from 1999 to 2013 on the number of hyperglycemic crisis episodes and diagnoses of diabetes and depressive disorder.

Adults with diabetes and depressive disorder experienced 2.87 hyperglycemic crisis episodes per 1,000 person-years, and adults with diabetes alone experienced 2.5 per 1,000 person-years. Hyperglycemic crisis episode risk among adults with diabetes and depressive disorder was 1.78 times greater than it was in adults with diabetes alone (HR = 1.78; 95% CI, 1.56-2.03). Men had 1.37 times greater risk vs. women (HR = 1.37; 95% CI, 1.26-1.49), and adults with a score of at least 3 on the Charlson Comorbidity Index had 3.47 times greater risk than those who had zero on the index (HR = 3.47; 95% CI, 3.01-4.01). In addition, a score of 1 to 2 on the Charlson Comorbidity Index was associated with a 2.28 times greater risk vs. a score of zero on the index (HR = 2.28; 95% CI, 2.07-2.51).

Diabetes syringe and stethoscope 2019 adobe 
Adults with diabetes and depressive disorder treated with antidepressant drugs experienced fewer episodes of hyperglycemic crisis than those not taking antidepressant medications.
Source: Adobe Stock

“Three reasons are provided to explain the mechanisms underlying the relationship between depression and the increased risk of hyperglycemic crisis episodes. First, the symptoms of depression created problems that prevented the self-management of diabetes,” the researchers wrote. “Second, multiple somatic complaints are often observed in patients with depression, which may lead physicians to be considered psychosomatic and forget the possibility of warning signs of poor glycemic control. ... Third, there may be a lack of continuity in diabetes care, as physical and mental illnesses are often treated separately, and geographical, administrative and resource separation creates ambiguity about the responsibility for the physical health of these patients.”

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The researchers further observed that 50.8% of adults with diabetes and depressive disorder used antidepressants on a long-term basis, which the researchers defined as “use equal to or greater than the median of all stimulants users.” According to the researchers, hyperglycemic crisis episode risk was cut by 59% if a participant used an antidepressant long term vs. not at all. (HR = 0.41; 95% CI, 0.34-0.49).

“This study highlights the need to pay more attention to the risk of hyperglycemic crisis episodes in diabetic patients with depression and the importance of proper use of antidepressants can reduce the risk of hyperglycemic crisis episodes,” the researchers wrote. – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.