Abstract
BackgroundTo confirm whether type 2 diabetes (T2DM) is an affective disorder (AD) precursor, and to establish possible effects of oral anti-hyperglycemic agents (OAAs).MethodsA representative cohort of 800,000 subjects was obtained from the Taiwanese National Health Insurance database on 1 January 2000. Those with consistent data (n = 762,753) were followed up between 1 January 1996 and 31 December 2007. Over this period, we assessed the presence (n = 62,988) or absence (n = 699,795) of T2DM, and whether any OAA was used (n = 40,232) or not (n = 22,756). To compare the risk of AD by diabetic status, those with T2DM were matched for birth date and gender with those without T2DM. To assess the effect of OAAs, we considered those 50 years and over. Matched AD-free patients with T2DM on OAAs were compared with those without OAAs, for age, gender, locality, health service, Charlson Comorbidity Index. and diabetes diagnosis date to avoid immortal time bias. AD incidence densities, hazard ratios (HR) and 95% confidence intervals (CIs) were calculated.ResultsCompared with diabetes-free subjects, the HR (95% CI) for AD was 2.62 (2.31 to 2.98) for patients with T2DM who were not on OAAs, and 1.08 (0.99 to 1.18) for those who were on OAAs. The AD incidence density decreased from 91.1 to 39.4 per 10,000 person-years for patients on the combination of metformin and sulfonylurea. The HR (95% CI) for AD was 0.92 (0.59 to 1.45) for those on metformin alone, 1.08 (0.84 to 1.38) for those on sulfonylurea alone, and 0.40 (0.32 to 0.50) for the combined treatment, and the decrease was not related to sequence or insulin usage. Similar patterns were seen for incident AD exclusion for up to 3 years, although more so for bipolar than unipolar.ConclusionsThe incident AD risk is increased by 2.6-fold in T2DM, and the combination of sulfonylurea and metformin minimizes this risk.
Highlights
To confirm whether type 2 diabetes (T2DM) is an affective disorder (AD) precursor, and to establish possible effects of oral anti-hyperglycemic agents (OAAs)
For subjects with T2DM who were on any OAA, compared with those who were diabetes-free, the hazard ratios (HR) of 1.06 (0.96 to 1.16) was not significant, but it represented a normalization of that for T2DM without OAA therapy
The analogous findings by gender and whether AD was unipolar or bipolar are shown. These indicate that the effects of diabetes and of OAA are similar for men and women and are irrespective of AD polarity
Summary
To confirm whether type 2 diabetes (T2DM) is an affective disorder (AD) precursor, and to establish possible effects of oral anti-hyperglycemic agents (OAAs). Studies of European and North American populations do indicate that diabetes is a precursor of depression [12,13,14]. Most of these studies have involved Caucasian populations, and there is little information about the issue in those ethnicities that are experiencing rapid and major increases in diabetes prevalence, such as northeast Asians. The prevalence of major depression in Taiwan was relatively low at 1.5%, compared with other populations; for instance it was 19.0% in Beirut [18]. By 2001, prevalence of major depression in older populations in Taiwan was 5.9% [19], comparable with international figures. Given the increasing diabetes prevalence, corresponding changes in depression or affective disorder (AD) rates might be expected if there is causality
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