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The Association Between Depression and Medication Non-Adherence in Type 2 Diabetes: A Population-Based Cohort Study
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Abstracts / Can J Diabetes 40 (2016) S27–S74
significant interaction of diabetes and psychiatric condition was found. Conclusions: In this nationally representative population study, the results indicated that diabetes and psychiatric conditions were each separately associated with lower levels of perceived social support. Future research should further examine these associations. 189 The Association Between Depression and Medication NonAdherence in Type 2 Diabetes: A Population-Based Cohort Study CARLOTTA LUNGHI*, ARSÈNE ZONGO, JOCELYNE MOISAN, JEAN-PIERRE GRÉGOIRE, LINE GUÉNETTE Quebec, QC Background: Depression has been correlated with suboptimal adherence to antidiabetic drug (AD) treatment in many studies. However, most of them were cross-sectional and the association and directionality of this relationship has not yet been established. Purpose: To measure the association between depression and nonadherence to AD treatment. Methods: We performed a population-based cohort study using the administrative data from the Quebec health insurance board (RAMQ) among adults newly using ADs. Depression was determined using a validated algorithm. To avoid immortal time bias, we carried out a depression diagnosis-time distribution matching by assigning a random fictive date of depression to individuals without depression. Non-adherence to AD treatment (i.e. <90% of days covered by at least 1 AD) in the 1-year period following depression diagnosis (real or fictive) was the main outcome. To estimate the effect of depression on AD treatment non-adherence, we conducted a multivariate logistic regression analysis, adjusting for baseline adherence and other potential confounders. Results: Between 2000 and 2006 we identified 3106 patients with a diagnosis of depression matched to 70,633 patients without depression. Among patients with depression, 52.0% were subsequently non-adherent with their AD treatment vs. 49% of patients without depression. Patients with depression were 24% more likely to be non-adherent to their AD treatment (adjusted odds ratio=1.24, 95% confidence interval: 1.13 to 1.37). Conclusions: Results suggest that depression is an independent risk factor of non-adherence to AD treatment. Patients with type 2 diabetes might benefit from regular detection for depression and adherence-enhancing interventions. 190 Inaccuracies in Diagnosing Diabetes Complicating Pregnancy and High Frequency of Pre-Existing Type 2 Diabetes in a Large Canadian Indigenous Community ELLEN L. TOTH, KRISTIN-LEE KEITH, RANDY LITTLECHILD, KARI MENEEN, JOY MYSKIW, KELLI BUCKREUS, RICHARD T. OSTER Edmonton, AB Aims: Diabetes complicating pregnancy may be a key factor contributing to the ongoing crisis of rising incidence/prevalence of diabetes in Indigenous populations. Optimal management is crucial and depends partly on accurate diagnosis. In collaboration with an Indigenous community, our objective was to investigate the diagnostic classifications from the diagnostic process for diabetes complicating pregnancy as per the Canadian Diabetes Association Clinical Practice Guidelines. Methods: Over a period of 5 years (2010 to 2015), we carefully examined the diagnostic process for diabetes complicating pregnancy among a series of 62 consecutively referred pregnancies to a diabetes education and treatment program on a large Indigenous community in Alberta, Canada.
Results: The 62 referrals represented approximately 50% of the pregnancies complicated by diabetes within the community. There were no referrals pre-conception and mean number of visits after referral was 3. Although all referrals except 5 stated “gestational diabetes,” chart review revealed only 40.3% could be correctly classified as such. The frequency of pre-existing type 2 diabetes was high, with 30.6% and 8.1% of women characterized as previously diagnosed and unrecognized overt type 2 diabetes in pregnancy, respectively. Unnecessary testing occurred in 8.1% of patients. Conclusions: Diagnoses of diabetes complicating pregnancy are likely challenged in many instances. Inaccuracies can stem from late presentations, insufficient screening at first visit, lack of recognition of pre-gestational diabetes, confusing guidelines, busy practitioners, uninformed clients, lack of pre-conception medical planning and systemic barriers to care. More awareness and simpler protocols may be needed. Pre-conception planning and first trimester testing are encouraged. 191 Gestational Weight Gain and Effects on Adverse Pregnancy Outcomes Among Women with Pre-Existing or Gestational Diabetes ERIN KEELY, AIDEEN MOORE Ottawa, ON Introduction: Increasing pre-pregnancy BMI and excessive gestational weight gain are associated with adverse pregnancy outcomes. Women with diabetes are also at higher risk for adverse pregnancy outcomes. There is little literature on the effects of weight gain in pregnant women with diabetes. Objectives: The objective of this study is to examine the impact of gestational weight gain on pregnancy outcomes among pregnant women with pre-existing or gestational diabetes. Methods: This retrospective cohort study (2012/13 to 2013/14) used data from the maternal child registry in Ontario (BORN). Gestational weight gain was grouped into less than recommended, recommended, more than recommended categories as per SOGC guidelines. Multiple logistic regression was used to assess association between pregnancy outcomes and both BMI and GWG. Statistical significance was assessed using chi-squared tests and/or t-tests (p<0.05). Results: Overall, 44% GDM, 58.7% type 1, 56.9% type 2 and 49.6% no diabetes gained more than the recommended amount of weight during their pregnancy. Women with GDM and type 2 who gained more than the recommended amount of weight showed a higher risk for hypertension and unplanned C-section. Gaining less than the recommended weight showed a higher risk of preterm delivery (<37 weeks) among women with no diabetes, type 2 diabetes and GDM. Conclusion: The results of this study suggest that pre-pregnancy BMI and gestational weight gain results in an additional burden on the health of pregnant women. Discussions on healthy weight and weight gain during pregnancy should be a routine conversation with all pregnant women to ensure optimal pregnancy outcomes.
Abstracts / Can J Diabetes 40 (2016) S27–S74
significant interaction of diabetes and psychiatric condition was found. Conclusions: In this nationally representative population study, the results indicated that diabetes and psychiatric conditions were each separately associated with lower levels of perceived social support. Future research should further examine these associations. 189 The Association Between Depression and Medication NonAdherence in Type 2 Diabetes: A Population-Based Cohort Study CARLOTTA LUNGHI*, ARSÈNE ZONGO, JOCELYNE MOISAN, JEAN-PIERRE GRÉGOIRE, LINE GUÉNETTE Quebec, QC Background: Depression has been correlated with suboptimal adherence to antidiabetic drug (AD) treatment in many studies. However, most of them were cross-sectional and the association and directionality of this relationship has not yet been established. Purpose: To measure the association between depression and nonadherence to AD treatment. Methods: We performed a population-based cohort study using the administrative data from the Quebec health insurance board (RAMQ) among adults newly using ADs. Depression was determined using a validated algorithm. To avoid immortal time bias, we carried out a depression diagnosis-time distribution matching by assigning a random fictive date of depression to individuals without depression. Non-adherence to AD treatment (i.e. <90% of days covered by at least 1 AD) in the 1-year period following depression diagnosis (real or fictive) was the main outcome. To estimate the effect of depression on AD treatment non-adherence, we conducted a multivariate logistic regression analysis, adjusting for baseline adherence and other potential confounders. Results: Between 2000 and 2006 we identified 3106 patients with a diagnosis of depression matched to 70,633 patients without depression. Among patients with depression, 52.0% were subsequently non-adherent with their AD treatment vs. 49% of patients without depression. Patients with depression were 24% more likely to be non-adherent to their AD treatment (adjusted odds ratio=1.24, 95% confidence interval: 1.13 to 1.37). Conclusions: Results suggest that depression is an independent risk factor of non-adherence to AD treatment. Patients with type 2 diabetes might benefit from regular detection for depression and adherence-enhancing interventions. 190 Inaccuracies in Diagnosing Diabetes Complicating Pregnancy and High Frequency of Pre-Existing Type 2 Diabetes in a Large Canadian Indigenous Community ELLEN L. TOTH, KRISTIN-LEE KEITH, RANDY LITTLECHILD, KARI MENEEN, JOY MYSKIW, KELLI BUCKREUS, RICHARD T. OSTER Edmonton, AB Aims: Diabetes complicating pregnancy may be a key factor contributing to the ongoing crisis of rising incidence/prevalence of diabetes in Indigenous populations. Optimal management is crucial and depends partly on accurate diagnosis. In collaboration with an Indigenous community, our objective was to investigate the diagnostic classifications from the diagnostic process for diabetes complicating pregnancy as per the Canadian Diabetes Association Clinical Practice Guidelines. Methods: Over a period of 5 years (2010 to 2015), we carefully examined the diagnostic process for diabetes complicating pregnancy among a series of 62 consecutively referred pregnancies to a diabetes education and treatment program on a large Indigenous community in Alberta, Canada.
Results: The 62 referrals represented approximately 50% of the pregnancies complicated by diabetes within the community. There were no referrals pre-conception and mean number of visits after referral was 3. Although all referrals except 5 stated “gestational diabetes,” chart review revealed only 40.3% could be correctly classified as such. The frequency of pre-existing type 2 diabetes was high, with 30.6% and 8.1% of women characterized as previously diagnosed and unrecognized overt type 2 diabetes in pregnancy, respectively. Unnecessary testing occurred in 8.1% of patients. Conclusions: Diagnoses of diabetes complicating pregnancy are likely challenged in many instances. Inaccuracies can stem from late presentations, insufficient screening at first visit, lack of recognition of pre-gestational diabetes, confusing guidelines, busy practitioners, uninformed clients, lack of pre-conception medical planning and systemic barriers to care. More awareness and simpler protocols may be needed. Pre-conception planning and first trimester testing are encouraged. 191 Gestational Weight Gain and Effects on Adverse Pregnancy Outcomes Among Women with Pre-Existing or Gestational Diabetes ERIN KEELY, AIDEEN MOORE Ottawa, ON Introduction: Increasing pre-pregnancy BMI and excessive gestational weight gain are associated with adverse pregnancy outcomes. Women with diabetes are also at higher risk for adverse pregnancy outcomes. There is little literature on the effects of weight gain in pregnant women with diabetes. Objectives: The objective of this study is to examine the impact of gestational weight gain on pregnancy outcomes among pregnant women with pre-existing or gestational diabetes. Methods: This retrospective cohort study (2012/13 to 2013/14) used data from the maternal child registry in Ontario (BORN). Gestational weight gain was grouped into less than recommended, recommended, more than recommended categories as per SOGC guidelines. Multiple logistic regression was used to assess association between pregnancy outcomes and both BMI and GWG. Statistical significance was assessed using chi-squared tests and/or t-tests (p<0.05). Results: Overall, 44% GDM, 58.7% type 1, 56.9% type 2 and 49.6% no diabetes gained more than the recommended amount of weight during their pregnancy. Women with GDM and type 2 who gained more than the recommended amount of weight showed a higher risk for hypertension and unplanned C-section. Gaining less than the recommended weight showed a higher risk of preterm delivery (<37 weeks) among women with no diabetes, type 2 diabetes and GDM. Conclusion: The results of this study suggest that pre-pregnancy BMI and gestational weight gain results in an additional burden on the health of pregnant women. Discussions on healthy weight and weight gain during pregnancy should be a routine conversation with all pregnant women to ensure optimal pregnancy outcomes.