Polypharmacy in Type 2 Diabetes Mellitus: Insights from an Internal Medicine Department

Abstract

Background and Objectives: Polypharmacy heavily impacts the quality of life of patients worldwide. It is a necessary evil in many disorders, and especially in type 2 diabetes mellitus, as patients require treatment both for this condition and its related or unrelated comorbidities. Thus, we aimed to evaluate the use of polypharmacy in type 2 diabetes mellitus vs. non-diabetes patients. Materials and Methods: A cross-sectional retrospective observational study was conducted. We collected the medical records of patients hospitalized in the Internal Medicine Clinic of the Clinical Emergency Hospital of Bucharest, Romania, for a period of two months (01/01/2018–28/02/2018). Patients diagnosed with type 2 diabetes mellitus were included in the study group, whereas patients who were not diabetic were used as controls. Results: The study group consisted of 63 patients with type 2 diabetes mellitus (mean age 69.19 ± 9.67 years, range 46–89 years; 52.38% males). The control group included 63 non-diabetes patients (mean age 67.05 ± 14.40 years, range 42–93 years, 39.68% males). Diabetic patients had more comorbidities (10.35 ± 3.09 vs. 7.48 ± 3.59, p = 0.0001) and received more drugs (7.81 ± 2.23 vs. 5.33 ± 2.63, p = 0.0001) vs. non-diabetic counterparts. The mean number of drug-drug and food-drug interactions was higher in type 2 diabetes mellitus patients vs. controls: 8.86 ± 5.76 vs. 4.98 ± 5.04, p = 0.0003 (minor: 1.22 ± 1.42 vs. 1.27 ± 1.89; moderate: 7.08 ± 4.08 vs. 3.54 ± 3.77; major: 0.56 ± 0.74 vs. 0.37 ± 0.77) and 2.63 ± 1.08 vs. 2.19 ± 1.42 (p = 0.0457), respectively. Conclusions: Polypharmacy should be an area of serious concern also in type 2 diabetes mellitus, especially in the elderly. In our study, type 2 diabetes mellitus patients received more drugs than their non-diabetes counterparts and were exposed to more drug-drug and food-drug interactions.

Mandarin multidimensional health literacy questionnaire for patient supporting groups

“…A drug bag design is also good for the issue of polypharmacy, especially in type 2 DM and other internal medicine department. [ 21 , 22 ] In this study, we also highlighted the importance of professionalism in drug bags and during face-to-face interactions with patients.…”

<p><em>CYP2C19</em>*<em>2</em> Polymorphism Is Associated with Impaired Oral Clearance of Gliclazide in Healthy Chinese</p>

“…[16][17][18] CYP2C9 polymorphisms (*2 or *3) are common in Caucasians but uncommon in Chinese with allele frequencies of 0.1% and 3%, respectively. 19 Conversely, to date, 20 Concomitant prescribing of CYP2C19 inhibitors, such as proton pump inhibitors and clopidogrel, may further affect the pharmacokinetics of gliclazide in patients who are CYP2C19 PMs.…”

Having Diabetes in a Middle-Income Country

“…Polypharmacy is an important part of diabetes management, and since not all drugs are available, some patients may be unable to reach therapeutic goals, presenting complications or switching to insulin-based treatments. 5 Healthcare systems also cover the costs of complications such as neuropathy, retinopathy, nephropathy or limb amputation; these are all complications that impact negatively on the economy taking out of the workforce otherwise productive individuals. Even with these systems, diabetes still represents a cost for the patient; changing to a healthier lifestyle and buying syringes and needles is a patient's responsibility, as well as the acquisition of a glucometer, lancets and paper strips for proper self-management.…”