title: The association between antidepressant use and hypoglycaemia in diabetic patients: a nested case-control study.
abstract: OBJECTIVE
  Hypoglycaemia is a limiting factor for glycaemic management of diabetes with intensive insulin and/or oral antidiabetic drug (OAD) regimen. Case reports suggest that antidepressants may interfere with blood glucose metabolism in patients with diabetes mellitus potentially increasing the risk of clinically relevant hypoglycaemia. Comorbid depression treated with antidepressants could therefore further complicate glycaemic control. We have carried out a nested case-control study among diabetic patients to assess the risk of hypoglycaemia requiring hospitalisation associated with the use of antidepressants.
  
  
  METHODS
  Diabetic patients treated with insulin and/or OADs were selected from the Dutch Pharmo system. Exposure to antidepressants was the primary determinant investigated. Use of antidepressants was further subclassified based on the receptor binding profile to investigate whether specific pharmacological properties could explain a potential influence on glucose homeostasis. Conditional logistic regression was used to estimate odds ratios and to adjust for confounding factors.
  
  
  RESULTS
  From the base cohort (40 600 patients), 549 (1.35%) cases were identified and 1897 controls were selected. Current use of any antidepressant was not associated with a significantly higher risk of hypoglycaemia requiring hospitalisation (OR: 1.36 (95%CI: 0.84-2.20)). A trend for a higher risk on hypoglycaemia was identified for antidepressants with high affinity for the serotonin reuptake transporter. The risk on severe hypoglycaemia was increased after 3 years of use (OR: 2.75 (95%CI: 1.31-5.77)).
  
  
  CONCLUSIONS
  It is important for diabetic patients using antidepressants for more than 3 years to pay attention for symptoms of hypoglycaemia and strict blood glucose self-monitoring.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands.
authors.forename: Hieronymus J
authors.initials: HJ
authors.lastname: Derijks
authors.forename: Eibert R
authors.initials: ER
authors.lastname: Heerdink
authors.forename: Fred H
authors.initials: FH
authors.lastname: De Koning
authors.forename: Robert
authors.initials: R
authors.lastname: Janknegt
authors.forename: Olaf H
authors.initials: OH
authors.lastname: Klungel
authors.forename: Antoine C
authors.initials: AC
authors.lastname: Egberts
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D004347:Drug Interactions; D005260:Female; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000378:metabolism; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D017891:Pharmacoepidemiology / Q000379:methods; D012307:Risk Factors
chemical_list: D000928:Antidepressive Agents; D001786:Blood Glucose; D007004:Hypoglycemic Agents