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Increased risk of affective disorders in type 2 diabetes is minimized by sulfonylurea and metformin combination: a population-based cohort study.
BMC Med. 2012 Nov 29; 10:150.BM

Abstract

BACKGROUND

To confirm whether type 2 diabetes (T2DM) is an affective disorder (AD) precursor, and to establish possible effects of oral anti-hyperglycemic agents (OAAs).

METHODS

A 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.

RESULTS

Compared 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.

CONCLUSIONS

The incident AD risk is increased by 2.6-fold in T2DM, and the combination of sulfonylurea and metformin minimizes this risk.

Authors+Show Affiliations

Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli, Taiwan 35053, ROC. profmlw@nhri.org.twNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23194378

Citation

Wahlqvist, Mark L., et al. "Increased Risk of Affective Disorders in Type 2 Diabetes Is Minimized By Sulfonylurea and Metformin Combination: a Population-based Cohort Study." BMC Medicine, vol. 10, 2012, p. 150.
Wahlqvist ML, Lee MS, Chuang SY, et al. Increased risk of affective disorders in type 2 diabetes is minimized by sulfonylurea and metformin combination: a population-based cohort study. BMC Med. 2012;10:150.
Wahlqvist, M. L., Lee, M. S., Chuang, S. Y., Hsu, C. C., Tsai, H. N., Yu, S. H., & Chang, H. Y. (2012). Increased risk of affective disorders in type 2 diabetes is minimized by sulfonylurea and metformin combination: a population-based cohort study. BMC Medicine, 10, 150. https://doi.org/10.1186/1741-7015-10-150
Wahlqvist ML, et al. Increased Risk of Affective Disorders in Type 2 Diabetes Is Minimized By Sulfonylurea and Metformin Combination: a Population-based Cohort Study. BMC Med. 2012 Nov 29;10:150. PubMed PMID: 23194378.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased risk of affective disorders in type 2 diabetes is minimized by sulfonylurea and metformin combination: a population-based cohort study. AU - Wahlqvist,Mark L, AU - Lee,Meei-Shyuan, AU - Chuang,Shao-Yuan, AU - Hsu,Chih-Cheng, AU - Tsai,Hsin-Ni, AU - Yu,Shu-Han, AU - Chang,Hsing-Yi, Y1 - 2012/11/29/ PY - 2012/05/17/received PY - 2012/11/29/accepted PY - 2012/12/1/entrez PY - 2012/12/1/pubmed PY - 2013/3/7/medline SP - 150 EP - 150 JF - BMC medicine JO - BMC Med VL - 10 N2 - BACKGROUND: To confirm whether type 2 diabetes (T2DM) is an affective disorder (AD) precursor, and to establish possible effects of oral anti-hyperglycemic agents (OAAs). METHODS: A 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. RESULTS: Compared 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. CONCLUSIONS: The incident AD risk is increased by 2.6-fold in T2DM, and the combination of sulfonylurea and metformin minimizes this risk. SN - 1741-7015 UR - https://www.unboundmedicine.com/medline/citation/23194378/Increased_risk_of_affective_disorders_in_type_2_diabetes_is_minimized_by_sulfonylurea_and_metformin_combination:_a_population_based_cohort_study_ L2 - https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-10-150 DB - PRIME DP - Unbound Medicine ER -