title: Does antidepressant adherence have an effect on glycemic control among diabetic antidepressant users?
abstract: OBJECTIVE
  To examine the relationship between adherence to antidepressant medications and HbA1c levels among patients with diabetes in a managed care setting.
  
  
  METHODS
  The analysis included measures of HbA1c levels before, during, and after initial antidepressant use among 568 patients with diabetes enrolled in the Harvard Pilgrim Health Care insurance plan from 1991-1995. Adherence was defined as four refills in a six-month period after the first antidepressant prescription. General linear models using SAS PROC MIXED were used to estimate the effects of covariates including antidepressant adherence on HbA1c levels over time, comparing patients who were adherent to antidepressant medications to those patients who were non-adherent to antidepressant medications.
  
  
  RESULTS
  Adherence to antidepressant treatment was not significantly associated with HbA1c levels among diabetic patients who are antidepressant users. Younger age, use of insulin and oral medications, and female gender were all significantly associated with HbA1c levels over time.
  
  
  CONCLUSIONS
  Although we did not observe any association between level of adherence to antidepressant therapy among diabetic patients and levels of glucose control, our results confirm previously established associations between patient characteristics and glycemic control. Further research is needed to disentangle the complex relationship among antidepressant treatment adherence and diabetes outcomes.
authors.affiliation: Dept. of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA. kzbambauer@post.harvard.edu
authors.forename: Kara Z
authors.initials: KZ
authors.lastname: Bambauer
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
authors.forename: Alyce S
authors.initials: AS
authors.lastname: Adams
authors.forename: Connie
authors.initials: C
authors.lastname: Mah
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: McLaughlin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology* / Q000378:metabolism; D004334:Drug Administration Schedule; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*
chemical_list: D000928:Antidepressive Agents; D006442:Glycated Hemoglobin