Polypharmacy linked to adverse outcomes in people with type 1 diabetes
medwireNews: Study findings presented at the virtual 56th EASD Annual Meeting indicate that polypharmacy is common among people with type 1 diabetes and is associated with an increased risk for adverse outcomes.
Andreas Höhn (University of Edinburgh, UK) and colleagues used the SCI-Diabetes Collaboration Database to evaluate the prevalence of polypharmacy in all patients in Scotland with type 1 diabetes on 1 January 2017.
Among these 28,245 people, 55.7% were men, the average age was 42.3 years, and the mean diabetes duration was 20.6 years. When insulin, treatment for hypoglycemia, and medical devices were excluded from the count, patients were taking an average of four additional drugs, most commonly agents targeting the cardiovascular and nervous systems.
Höhn reported that polypharmacy increased with age; the proportion of individuals taking five or more drugs rose from 2% among those aged 19 years or under to 29% in those aged 40–49 years and 76% in those aged 80 years and older.
He also pointed to “very striking” differences in the prevalence of polypharmacy when patients were categorized by sex and socioeconomic deprivation. The proportion of people taking five or more drugs was higher among women than men, “indicating that the burden of multimorbidity is likely to be higher among women,” Höhn explained.
Moreover, people of either sex were more likely to be taking five or more drugs if they were in higher versus lower quintiles for socioeconomic deprivation, according to the Scottish Index of Multiple Deprivation, and this difference was “more strongly pronounced” among women relative to men, he added.
The presenter said that there was a “strong association” between polypharmacy and adverse health outcomes, including complications of diabetes. Each additional drug was associated with a significant 5% increased risk for hypoglycemia and a 2% increased risk for death in a multivariate analysis adjusted for factors including sex, age, diabetes duration, and glycemic control.
Höhn noted that the use of nervous system agents in particular – including opioids, antipsychotics, and antidepressants – was associated with an increased risk for adverse outcomes.
“While some cases of polypharmacy are necessary, beneficial, and unavoidable […], our findings highlight that a careful review of prescribed drugs is very important,” he said.
And he recommended that in such reviews, “clinicians should reflect on both the number of prescribed drugs as well as the prescription of particular drug classes, as both can increase the risk of diabetes-related complications.”
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