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Behavioral and Pharmacoepidemiological Risk Factors and Mediators for Type II Diabetes Mellitus

Zigmont, Victoria Ann

Abstract Details

2015, Doctor of Philosophy, Ohio State University, Public Health.
BACKGROUND: Type II diabetes mellitus (T2DM) is a serious and relevant public health problem. Lifestyle programs like the Diabetes Prevention Program (DPP) can delay a patient’s progression to T2DM. Identifying which patients are likely to enroll in these programs and tailoring recruitment approaches to those with perceived barriers is one way to increase engagement in health promotion. Previous literature on antidepressant use and T2DM has raised concerns that antidepressant use is associated with T2DM, however these studies have been variable in quality. Similarly, while statins are one of the most widely prescribed medications in the United States; concern has been raised that they are associated with incident T2DM. The effect of statin use on glycemic control in nondiabetic patients is currently unclear. METHODS: Three retrospective cohort studies were conducted among individuals in the Midwest enrolled in an insurance plan from 2011 through 2014. These studies combined data from medical and pharmacy claims, annual biometric screenings and a health survey. The goal of the first study was to identify differences between prediabetic patients who did and did not volunteer to enroll in a worksite DPP. Covariates were compared for prediabetics who did and did not elect to participate in the DPP using multivariable logistic regression (n=2,158). Generalized linear mixed models with random intercepts were then used to compare biometric trajectories for the two groups. The goal of studies two and three was to identify if antidepressant or statin users who were members of this insurance cohort were at risk for elevated HbA1c or T2DM development. The second study was restricted to patients with indications for antidepressant use (n=2,063) and the third study was among patients with indications for statin use (n=7,064). The methods were identical for studies two and three. Elevated glycosylated hemoglobin A1c (HbA1c) was compared for nondiabetic antidepressant, or statin, users and nonusers after applying inverse probability weighting with logistic regression for the outcome of elevated HbA1c (>6.0). To evaluate the risk of T2DM development, Cox proportional hazard models with time varying antidepressant, or statin, use compared incident T2DM diagnoses among antidepressant or statin users and nonusers. Comparisons were also made by duration of use and class for antidepressant, or statin, users and nonusers and intensity of dose was compared for statin users. RESULTS: The first analysis identified that prediabetics were more likely to express interest in the DPP if they were female, African American, older, free of hypertension, had more doctor visits, or lower self-efficacy to make healthy lifestyle changes. The second analysis found no differences in elevated HbA1c, or new onset T2DM, across antidepressant users, or duration of use. The third analysis found no differences in elevated HbA1c, however new onset of T2DM was highest among statin users who had been taking statins for 2 years or longer; no differences were observed by statin class. CONCLUSION: Current recruitment strategies are reaching individuals who are not representative of the greater prediabetic population. Targeted recruitment efforts for underrepresented groups are currently underway. A higher prevalence of elevated HbA1c was not observed among nondiabetic users of antidepressants or statins after controlling for baseline differences across groups. Additionally these findings indicate that the elevated T2DM risk among statin users may be isolated to a group of patients with higher T2DM risk, and for antidepressant users, an elevated risk of T2DM was not observed.
Susan Olivo-Marston, PhD, MPH (Advisor)
Steven Clinton, MD, PhD (Committee Member)
Randall Harris, MD, PhD (Committee Member)
Gail Kaye, PhD, RD, LD, PLCC (Committee Member)
Abigail Shoben, PhD (Committee Member)
211 p.

Recommended Citations

Citations

  • Zigmont, V. A. (2015). Behavioral and Pharmacoepidemiological Risk Factors and Mediators for Type II Diabetes Mellitus [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1448978472

    APA Style (7th edition)

  • Zigmont, Victoria. Behavioral and Pharmacoepidemiological Risk Factors and Mediators for Type II Diabetes Mellitus. 2015. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1448978472.

    MLA Style (8th edition)

  • Zigmont, Victoria. "Behavioral and Pharmacoepidemiological Risk Factors and Mediators for Type II Diabetes Mellitus." Doctoral dissertation, Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1448978472

    Chicago Manual of Style (17th edition)