7440 Both GLP-1RA and SGLT2i medications are associated with lower depression scores in veterans compared to metformin and insulin
Authors: Ubalde Shannen Nicole Dean , Cann Halle , Esper Layal , Powell Joseph , Meyer Kristin , Sen Sabyasachi 
Published: October 2024

Abstract
Disclosure: S.D. Ubalde: None. H. Cann: None. L. Esper: None. J. Powell: None. K. Meyer: None. S. Sen: None.
Background: Type 2 diabetes (T2DM) and depression are considered bidirectional. Depression and mental health issues are often co-morbidities and present with management challenges in veterans with T2DM. With the advent of novel meds for T2DM, it is important to choose appropriate T2DM medication in this context.Glucagon-like-peptide-1 receptor agonists (GLP-1RA) act on the hypothalamus to reduce weight and glycemic indices in T2DM patients which may play a positive role on the amygdala and help improve mood and depression. We hypothesized that patients taking the GLP1-RA (+/-insulin) regimen would have lower PHQ-9 depression scores compared to patients taking SGLT2i (+/-insulin), metformin (+/- insulin), or insulin (ins) alone. Methods: We conducted a retrospective chart review of patients from the Diabetes Clinic at VA Med Center over 10 months to find an association between PHQ9 depression scores and anti-diabetic regimen. We reviewed 200 patient charts and decided to analyze 88 subjects that had bonafide depression that is PHQ-9 score of at least 5 or above including mild, moderate, and severe depression as per the PHQ9 scoring system. Results: Our cohort had a mean age of 64.16±1.18 years. All patients were either overweight or had obesity (BMI 25-45). Percentage prescriptions of different diabetes medications show that most patients are on insulin alone with 35 patients (39.77%), while Metformin (+/- ins) had 23 (26.14%), GLP-1RA (+/- ins) had 17 (19.32%), and with the lowest use in SGLT2i (+/- ins) had 13 (14.77%). The mean BMI was 32.29±0.80, which was similar across the groups with the SGLT2i (+/- ins) group having a slightly lower BMI of 27.80±1.28. Mean A1C was 8.0±0.2 with no difference found between groups. Comparing depression scores between all groups the Brown-Forsythe ANOVA test analysis showed significance of p = 0.0383 among all groups. Contrary to our hypothesis, both GLP-1RA and SGLT2i groups (rather than GLP1RA alone) had a significantly lower mean PHQ-9 score of 8.824±0.81(p = 0.0486, using unpaired t-test) and 8.077±0.91 (p = 0.0311) respectively, compared to the metformin group with a score of 12.04±1.2. Insulin-only group score was slightly lower than metformin at 11.03±0.95, and there was no statistical difference when compared to other groups. Conclusion: In a real-life setting of T2DM clinic subjects that were overweight or obese, depression scores were lower in patients taking the GLP1RA and SGLT2i. This effect was independent of differences in BMI or A1C metrics between the groups. The majority of T2DM veteran patients were prescribed insulin alone indicating under-utilization of novel T2DM meds such as SGLT2i and GLP1A agents. Continuing this research, particularly in a VAMC cohort, may provide insight into the choice of appropriate T2DM medications that may help veterans with concomitant T2DM and depression.
Presentation: 6/2/2024