Examining the risk of depression or self-harm associated with incretin-based therapies used to manage hyperglycaemia in patients with type 2 diabetes: a cohort study using the UK Clinical Practice Research Datalink
| Autor: | John-Michael Gamble, Laurie Twells, William K. Midodzi, Sumit R. Majumdar, Eugene Chibrikov |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
dipeptidyl-peptidase 4 inhibitors medicine.medical_specialty Population Incretin Poison control 030209 endocrinology & metabolism Type 2 diabetes Glucagon-Like Peptide-1 Receptor self-harm Cohort Studies 03 medical and health sciences 0302 clinical medicine Internal medicine cohort study History of depression Humans Hypoglycemic Agents Medicine 030212 general & internal medicine glucagon-like receptor 1 agonists education suicide Depression (differential diagnoses) Dipeptidyl-Peptidase IV Inhibitors education.field_of_study Primary Health Care Depression business.industry Incidence Research Incidence (epidemiology) General Medicine Middle Aged medicine.disease United Kingdom 3. Good health Diabetes and Endocrinology Diabetes Mellitus Type 2 Female type 2 diabetes business Self-Injurious Behavior Cohort study |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| DOI: | 10.1136/bmjopen-2018-023830 |
| Popis: | ObjectivesTo compare population-based incidence rates of new-onset depression or self-harm in patients initiating incretin-based therapies with that of sulfonylureas (SU) and other glucose-lowering agents.DesignPopulation-based cohort study.SettingPatients attending primary care practices registered with the UK-based Clinical Practice Research Datalink (CPRD).ParticipantsUsing the UK-based CPRD, we identified two incretin-based therapies cohorts: (1) dipeptidyl peptidase-4 inhibitor (DPP-4i)-cohort, consisting of new users of DPP-4i and SU and (2) glucagon-like peptide-1 receptor agonists (GLP-1RA)-cohort, consisting of new users of GLP-1RA and SU, between January 2007 and January 2016. Patients with a prior history of depression, self-harm and other serious psychiatric conditions were excluded.Main outcome measuresThe primary study outcome comprised a composite of new-onset depression or self-harm. Unadjusted and adjusted Cox proportional hazards regression was used to quantify the association between incretin-based therapies and depression or self-harm. Deciles of High-Dimensional Propensity Scores and concurrent number of glucose-lowering agents were used to adjust for potential confounding.ResultsWe identified new users of 6206 DPP-4i and 22 128 SU in the DPP-4i-cohort, and 501 GLP-1RA and 16 409 SU new users in the GLP-1RA-cohort. The incidence of depression or self-harm was 8.2 vs 11.7 events/1000 person-years in the DPP-4i-cohort and 18.2 vs 13.6 events/1000 person-years in the GLP-1RA-cohort for incretin-based therapies versus SU, respectively. Incretin-based therapies were not associated with an increased or decreased incidence of depression or self-harm compared with SU (DPP-4i-cohort: unadjusted HR 0.70, 95% CI 0.51 to 0.96; adjusted HR 0.80, 95% CI 0.57 to 1.13; GLP-1RA-cohort: unadjusted HR 1.36, 95% CI 0.72 to 2.58; adjusted HR 1.25, 95% CI 0.63 to 2.50). Consistent results were observed for other glucose-lowering comparators including insulin and thiazolidinediones.ConclusionsOur findings suggest that the two incretin-based therapies are not associated with an increased or decreased risk of depression or self-harm. |
| Databáze: | OpenAIRE |
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