GLP-1RAs may offer modest antidepressant effects compared to DPP4is but not SGLT-2is

Follow @Annalsofim on X, Facebook, Instagram, threads, and Linkedin        
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.         
----------------------------      

1. GLP-1RAs may offer modest antidepressant effects compared to DPP4is but not SGLT-2is

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01347

URL goes live when the embargo lifts           

A target trial emulation study compared risk for depression among older adults with type 2 diabetes initiating treatment with glucagon-like peptide-1 agonists (GLP-1RAs) versus sodium–glucose cotransporter-2 inhibitors (SGLT2is) or dipeptidyl peptidase-4 inhibitors (DPP4is). The data showed that risk for depression was low overall, with no difference in incidence when comparing GLP-1RAs to SGLT2is and a modestly reduced risk with GLP-1RAs compared to DPP4is. The findings are published in Annals of Internal Medicine.

Some research has suggested the potential of GLP-1RAs to alleviate depression symptoms due to its ability to cross the blood-brain barrier, however, population-based studies have yielded inconsistent results. Researchers from the University of Florida used U.S. national Medicare claims data between January 2013 and December 2020 to emulate a target trial assessing the risk of depression among older adults with diabetes initiating treatment with GLP-1RAs, SGLT2is or DPP4is. Participants were randomly assigned treatment to one of the three medications and were followed until the onset of depression, death, loss to follow-up, up to 2 years of follow-up, or the end of the study, whichever came first. There were 14,665 pairs of patients in the cohort for GLP-1RAs versus SGLT2is and 13,711 pairs in the cohort for GLP-1RAs versus DPP4is. Over the follow up period, 961 GLP-1RA users and 902 SGLT2i users were diagnosed with depression, indicating very little difference in risk for depression between GLP-1RAs and SGLT2is. In the cohort comparing GLP-1RA and DPP4is treatment, 963 and 1075 depression events occurred, respectively, suggesting an antidepressant effect of GLP-1RAs. More research is needed to confirm these findings; however, the findings could have important implications on the management of diabetes and depression in older adults.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Jingchuan Guo, MD, PhD, please email Matt Splett at msplett@ufl.edu.

---------------------------- 

2. No difference in prevalence of common chronic conditions between Medicare Advantage and fee-for-service populations

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01531

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00088

URL goes live when the embargo lifts          

A nationally representative cross-sectional study aimed to determine the prevalence of chronic conditions among Medicare Advantage (MA) beneficiaries compared to those in fee-for-service (FFS) Medicare. The study found that prevalence of obesity, hypertension, hyperlipidemia and chronic kidney disease was not higher among MA compared to FFS beneficiaries, however, diabetes was more prevalent in MA beneficiaries. The findings suggest that excess payments to MA plans over the past 15 years may be driven more by diagnosis and coding practices rather than differences in disease burden by populations. The study is published in Annals of Internal Medicine.

Researchers from Beth Israel Deaconess Medical Center and colleagues studied data from 2,446 adults aged 65 and older obtained from the National Health and Nutrition Examination Survey (NHANES) between 2015 to 2018 and Medicare enrollment files. They sought to determine how biometric and lab markers of overall health (BMI, blood pressure, total cholesterol concentration, HgbA1c concentration, and eGFR) compare between MA and FFS beneficiaries and whether the prevalence of common chronic conditions (obesity, hypertension, hyperlipidemia, diabetes, and chronic kidney disease) is higher in MA beneficiaries. The researchers found that MA and FFS beneficiaries had very similar BMI, blood pressure, total cholesterol concentration, eGFR levels. MA beneficiaries had slighter higher average HgbA1c levels than FFS beneficiaries. According to the authors, this study provides a more accurate population-based estimate of health markers and chronic condition prevalence because it used direct physical examination and lab data, whereas prior work relied on administrative billing data and patient surveys.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Andrew Oseran, please email aoseran@bidmc.harvard.edu.

---------------------------- 

Also new in this issue:

Development of prompt templates for LLM-driven screening in systematic reviews

Christian Cao, MD, et al.

Research and Reporting Methods

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02189

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00012