Impact of depression on treatment progression in type 2 diabetes: A UK retrospective cohort study using the Clinical Practice Research Datalink Aurum database.

Abstract

To investigate the association between depression history, timing, and progression of diabetes treatment in type 2 diabetes (T2D). We conducted a cohort study using primary care records from the Clinical Practice Research Datalink Aurum database (2011-2023). Adults with T2D initiating oral glucose-lowering monotherapy (index) were included. Depression history, identified using clinical codes, was categorised by the most recent code before index: recent (≤1.7 years), intermediate (1.7-12.8 years), distant (>12.8 years), or none. Outcomes were time to treatment intensification (adding or switching drug class) and insulin initiation. We used Royston-Parmar survival models to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for demographic and clinical variables. Among 378,935 included individuals, 25.1% had a history of depression. Compared with no prior depression, recent depression was associated with higher odds of treatment intensification (OR 1.20, 95% CI: 1.17-1.23) and insulin initiation (OR 1.29, 95% CI: 1.23-1.36). Intermediate and distant depression were also associated with higher progression-odds, but effect sizes were small, particularly for distant depression. Depression, particularly recent episodes, is associated with earlier treatment progression in T2D, highlighting the importance of integrating mental and physical healthcare in diabetes management.