The Use of Antidepressants, Anxiolytics, and Hypnotics in People with Type 2 Diabetes and Patterns Associated with Use: The Hoorn Diabetes Care System Cohort

Abstract

Objective. With depression being present in approximately 20% of people with type 2 diabetes mellitus (T2DM), we expect equally frequent prescription of antidepressants, anxiolytics, and hypnotics. Nevertheless, prescription data in people with T2DM is missing and the effect of depression on glycaemic control is contradictory. The aim of this study was to assess the prevalence of antidepressants, anxiolytics, and/or hypnotics use in a large, managed, primary care system cohort of people with T2DM and to determine the sociodemographic characteristics, comorbidities, T2DM medication, and metabolic control associated with its use. Method. The prevalence of antidepressants, anxiolytics, and/or hypnotics use in the years 2007–2012 was assessed in the Hoorn Diabetes Care System Cohort from the Netherlands. Results. From the 7016 people with T2DM, 500 people (7.1%) used antidepressants only, 456 people (6.5%) used anxiolytics and/or hypnotics only, and 254 people (3.6%) used a combination. Conclusion. We conclude that in our managed, primary care system 17% of all people with T2DM used antidepressants, anxiolytics, and/or hypnotics. Users of antidepressants, anxiolytics, and/or hypnotics were more often female, non-Caucasian, lower educated, and more often treated with insulin.

Incident psychopharmacological treatment and psychiatric hospital contact in individuals with newly developed type 2 diabetes

“…The finding from our current study, namely that 5.6% and 2.9% of the individuals with newly developed T2D initiated antidepressant- and anxiolytic treatment, respectively, within two years, is somewhat contrasting to prior studies in the field (incidence of 7.10-10.4% for antidepressant treatment and 6.5% for anxiolytic treatment) (Mast et al, 2017, Perez et al, 2017, Cleal et al, 2018, Kivimäki et al, 2010). However, in contrast to most other studies, we excluded individuals having received psychopharmacological treatment or having had a psychiatric hospital contact within the five years leading up to the onset of T2D, in order to get better estimates of the true incidence of the need for psychopharmacological treatment and specialist psychiatric care (hospital contact) among individuals with newly developed T2D.…”

“…The finding from our current study, namely that 5.6% and 2.9% of the individuals with newly developed T2D initiated antidepressant-and anxiolytic treatment, respectively, within two years, is somewhat contrasting to prior studies in the field (incidence of 7.10-10.4% for antidepressant treatment and 6.5% for anxiolytic treatment) (Mast et al, 2017, Perez et al, 2017, Cleal et al, 2018, Kivimäki et al, 2010.…”

“…Specifically, prior studies have shown that individuals with T2D are twice as likely to exhibit symptoms of depression, anxiety, insomnia, and distress compared to the general population (Semenkovich et al, 2015, Collins et al, 2009, Khuwaja et al, 2010, Smith et al, 2013, Tan et al, 2018, Hackett and Steptoe, 2017, Ducat et al, 2014) - with up to one out of five developing major depression (Semenkovich et al, 2015). Accordingly, prior studies have established that individuals with T2D are more likely to use antidepressants than individuals from the general population (Manderbacka et al, 2011); with the prevalence of antidepressant use in T2D ranging between 7-10% (Mast et al, 2017, Ivanova et al, 2010, Manderbacka et al, 2011). In addition, the prevalence of anxiolytic/hypnotic has been estimated at 7% (Mast et al, 2017).…”

“…Prior studies that have investigated psychopharmacological treatment and need for psychiatric hospital care in individuals with T2D are mainly limited by three things. First, studies aiming at studying these aspects in individuals with newly developed T2D have often not had the exact date of T2D diagnosis at their disposal, and therefore focused on selected populations using T2D treatment initiation or hospitalization as a proxy for the onset of T2D (Mast et al, 2017, Cleal et al, 2018. Second, prior studies have generally not been able to take preexisting mental illness or psychopharmacological treatment into account (Mast et al, 2017, Perez et al, 2017, Cleal et al, 2018, Kivimäki et al, 2010, i.e.…”

“…whether the need for treatment arose before or after the development of T2D. Third, adjustment for potential confounders of the association between T2D and psychopharmacological treatment requires access to information that has not been available in many prior studies (Mast et al, 2017, Perez et al, 2017, Cleal et al, 2018, Kivimäki et al, 2010.…”