Polypharmacy up, potentially inappropriate medication down in older diabetic patients

An increasing trend in polypharmacy has been observed in both older and middle-aged people with diabetes, particularly in patients between 55 and 64 years of age, according to a study. However, a decrease in potentially inappropriate medication (PIM) is seen in older patients with polypharmacy.

“The most common PIMs in people with diabetes were similar to those seen in the general population,” the researchers said. “Further efforts are needed to decrease the use of PIMs in populations already burdened with many drugs.”

The University Groningen IADB.nl prescription database was used to carry out this repeated cross-sectional study, which included all people aged ≥45 years treated for diabetes and registered in the period 2012–2016. Polypharmacy was evaluated in three age groups.

The researchers assessed PIMs using Beers criteria for people aged ≥65 years and Prescribing Optimally in Middle-aged People’s Treatments (PROMPT) criteria for those aged 45–64 years. They also performed chi-square tests and regression analysis.

From 2012 to 2016, polypharmacy prevalence significantly increased in all age groups. By 2016, polypharmacy prevalence stood at 36.9 percent in patients aged 45–54 years, 50.3 percent in those aged 55–64 years, and 66.2 percent in those aged ≥65 years. [Br J Clin Pharmacol 2021;87:2807-2817]

“The findings of this study confirm that polypharmacy is a concern in people with diabetes, with the highest rate in older-age patients,” the researchers said, adding that the increasing trend among diabetics was similar to that in the general population. [PLoS ONE 2019;14:e0214240; BMC Med 2015;13:74-83; BMJ Open 2018;8:e020852; Medicina 2019;55:436-445; Acta Diabetol 2016;53:323-330]

Of note, the absolute increase in patients aged 55­–64 years was greater than in those aged ≥65 years, which might indicate an increase in the number of comorbidities in the former cohort, followed by a further increase in prescribing of medication.

“For middle-aged patients, prescribers may not yet see polypharmacy as a large burden or problem,” the researchers said. “So far, attention for polypharmacy management is more focused on older than middle-aged people.” [BMC Fam Pract 2017;18:70-78]

On the other hand, the prevalence of older people having at least one PIM dropped by 3.1 percent, but this increased among middle-aged patients by 0.9 percent during the study period. In both age groups, the most common PIMs were long-term high-dose proton pump inhibitors, benzodiazepines, and strong opioids without laxatives. Of these medications, only benzodiazepines indicated a decreasing trend.

Using the PROMPT criteria, the researchers found similar PIMs in a general middle-aged population. Benzodiazepines were also a common PIM in the general older-age population, with prevalence rates ranging from 0.74 percent to 3.9 percent. [Pharmacoepidemiol Drug Saf 2009;18:1125-1133; Br J Clin Pharmacol 2005;60:137-144]

With the Beers criteria, the most prevalent PIMS were from the opioid group, the antidepressant group, and digoxin. [Pharmacoepidemiol Drug Saf 2009;18:1125-1133; Br J Clin Pharmacol 2005;60:137-144; J Am Geriatr Soc 2016;64:788-797]

“Our findings indicate that prescribers appear not to be more cautious with prescribing these PIMs in older people with or without having diabetes,” the researchers said. “Apparently, substantial numbers of people with diabetes require these drugs according to their physicians.”