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Justin Gagnon 2016

Page history last edited by reem.elsherif@mail.mcgill.ca 4 years, 10 months ago

Gagnon, Justin (2016). The association between antidepressant therapy and glycemic control in patients with diabetes: a Canadian primary care cohort. McGill Family Medicine Studies Online, 11: e01.


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Context: Antidepressants (AD) are among the most prescribed medications in Canada. Research has found an association between certain ADs and impaired glycemic control, which contributes to an increase in risk of complications for people with diabetes. Evidence on the impact of different ADs on glucose metabolism is inconclusive as studies in this area are largely heterogeneous and find contradictory or non-significant results. The objectives of this research are to describe the prescription of ADs for people with diabetes in Canada, and measure the impact of the most commonly prescribed ADs on glycemic control.


Methods: A retrospective cohort study was conducted using primary care electronic medical records collected by the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). The CPCSSN dataset used in this research comprised the electronic medical records extracted in September of 2014 from 115 primary care practices across Canada. Descriptive statistics were used to describe the prescription of ADs for people with diabetes. A generalized linear mixed (GLM) model was computed to estimate the impact of the five most commonly prescribed ADs on HbA1c.


Results: In 2014, the most commonly prescribed ADs for people with diabetes were, in order of frequency, Citalopram (16.6%), Amitriptyline (16.2%), Venlafaxine (15.7%), Trazodone (14.2%) and Escitalopram (12.4%). Estimates for the impact of ADs on HbA1c generated by the GLM model were reported in terms of mean HbA1c ratios relative to Citalopram, the most commonly prescribed AD. Overall, the impact of Amitriptyline, Venlafaxine, Trazodone and Escitalopram on HbA1c did not differ significantly from Citalopram. Sensitivity analyses examining the impact of the ADs on HbA1c for different periods of exposure showed a tendency of lower HbA1c between 6 and 12 months of exposure for Trazodone (0.95; 95% CI=0.88 to 1.04) and Escitalopram (0.93; 95% CI=0.84 to 1.03) relative to Citalopram.


Discussion: The results of this research suggest that for prolonged use, Trazodone and Escitalopram may be more effective than Citalopram, the most prescribed AD, for people with diabetes. Future research should seek to confirm these findings, examine the dose-response relationship between ADs and change in HbA1c, and control for depression severity and weight change.


Conclusion: This appears to be the first pan-Canadian epidemiological study of primary care practices describing the prescription of ADs for people with diabetes. This is also one of few epidemiological studies conducted using electronic medical records which examine the impact of ADs on HbA1c using robust statistical analyses for repeated measures which take into account within- and between-subject variation over time.




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