IMPACT OF COMORBID DEPRESSION ON INSULIN INITIATION AND CARDIOVASCULAR OUTCOMES AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS: A MULTINATIONAL OHDSI COHORT STUDY
Author(s)
Christianus Heru Setiawan, Master1, Phan Thanh Phuc, PhD2, Septi Melisa, Master2, Jason C. Hsu, PhD1;
1Taipei Medical University, New Taipei City, Taiwan, 2Taipei Medical University, Taipei, Taiwan
1Taipei Medical University, New Taipei City, Taiwan, 2Taipei Medical University, Taipei, Taiwan
OBJECTIVES: Depression commonly coexists with T2DM and may worsen metabolic and cardiovascular risk, yet its links to insulin initiation and major cardio-cerebrovascular outcomes across healthcare systems remain unclear. Using a harmonized multinational observational framework, we assessed the impact of comorbid depression on insulin initiation and cardiovascular events in patients with T2DM.
METHODS: A retrospective cohort study was conducted using electronic health record data transformed into the Observational Medical Outcomes Partnership Common Data Model across three academic databases (Taipei Medical University Clinical Research Database, Yonsei University Health System, and Ajou University School of Medicine). Adult patients with T2DM initiating oral glucose-lowering therapy were classified into depression and non-depression cohorts based on diagnostic and pharmacologic criteria. Propensity score stratification was applied to balance demographic, clinical, and healthcare utilization covariates. Primary outcome was insulin initiation (≥30 consecutive days). Secondary outcomes included acute coronary syndromes, myocardial infarction, and stroke. Cox proportional hazards models were estimated within each database and synthesized using random-effects meta-analysis. Prespecified sensitivity analyses assessed robustness across alternative exposure definitions, propensity score matching strategies, and time-at-risk specifications.
RESULTS: Across databases, baseline characteristics were well balanced after adjustment. Meta-analysis demonstrated a significantly higher risk of insulin initiation among patients with comorbid depression compared with those without depression (hazard ratio [HR] 1.77; 95% confidence interval [CI] 1.03-3.06). Depression was also associated with increased risks of acute coronary syndromes (HR 1.74; 95% CI 1.17-2.59), myocardial infarction (HR 1.31; 95% CI 1.02-1.68), and stroke (HR 3.38; 95% CI 1.41-8.12). Sensitivity analyses were consistent, with stroke showing the strongest and most robust association across analyses.
CONCLUSIONS: Comorbid depression in patients with T2DM was linked to earlier insulin initiation and markedly higher risks of cardiovascular and cerebrovascular events across healthcare systems, highlighting the importance of integrated mental health care and targeted interventions in diabetes management.
METHODS: A retrospective cohort study was conducted using electronic health record data transformed into the Observational Medical Outcomes Partnership Common Data Model across three academic databases (Taipei Medical University Clinical Research Database, Yonsei University Health System, and Ajou University School of Medicine). Adult patients with T2DM initiating oral glucose-lowering therapy were classified into depression and non-depression cohorts based on diagnostic and pharmacologic criteria. Propensity score stratification was applied to balance demographic, clinical, and healthcare utilization covariates. Primary outcome was insulin initiation (≥30 consecutive days). Secondary outcomes included acute coronary syndromes, myocardial infarction, and stroke. Cox proportional hazards models were estimated within each database and synthesized using random-effects meta-analysis. Prespecified sensitivity analyses assessed robustness across alternative exposure definitions, propensity score matching strategies, and time-at-risk specifications.
RESULTS: Across databases, baseline characteristics were well balanced after adjustment. Meta-analysis demonstrated a significantly higher risk of insulin initiation among patients with comorbid depression compared with those without depression (hazard ratio [HR] 1.77; 95% confidence interval [CI] 1.03-3.06). Depression was also associated with increased risks of acute coronary syndromes (HR 1.74; 95% CI 1.17-2.59), myocardial infarction (HR 1.31; 95% CI 1.02-1.68), and stroke (HR 3.38; 95% CI 1.41-8.12). Sensitivity analyses were consistent, with stroke showing the strongest and most robust association across analyses.
CONCLUSIONS: Comorbid depression in patients with T2DM was linked to earlier insulin initiation and markedly higher risks of cardiovascular and cerebrovascular events across healthcare systems, highlighting the importance of integrated mental health care and targeted interventions in diabetes management.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO50
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)