Associated adverse health outcomes of polypharmacy and potentially inappropriate medications in community-dwelling older adults with diabetes

Lvliang Lu; Shuang Wang; Jiaqi Chen; Yujie Yang; Kai Wang; Jing Zheng; Pi Guo; Yunpeng Cai; Qingying Zhang

doi:10.3389/fphar.2023.1284287

Associated adverse health outcomes of polypharmacy and potentially inappropriate medications in community-dwelling older adults with diabetes

Front Pharmacol. 2023 Nov 16:14:1284287. doi: 10.3389/fphar.2023.1284287. eCollection 2023.

Authors

Lvliang Lu^#¹, Shuang Wang^#², Jiaqi Chen¹, Yujie Yang³, Kai Wang¹, Jing Zheng², Pi Guo¹, Yunpeng Cai³, Qingying Zhang¹

Affiliations

¹ Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China.
² Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong, China.
³ Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China.

^# Contributed equally.

Abstract

Aim: This study aimed to identify the association of chronic polypharmacy and potentially inappropriate medications (PIMs) with adverse health outcomes (AHOs) in community-dwelling older adults with diabetes in China. Methods: A 2-year retrospective cohort study was conducted using 11,829 community-followed older adults with diabetes and medical records from 83 hospitals and 702 primary care centers in Shenzhen, China. Chronic polypharmacy and PIMs were identified from prescription records using Beers' criteria, and their associated AHO was analyzed using multivariable logistic regression analysis. Results: The prevalence of chronic polypharmacy and at least one PIM exposure was 46.37% and 55.09%, respectively. The top five PIMs were diuretics, benzodiazepines, first-generation antihistamines, sulfonylureas, and insulin (sliding scale). Chronic polypharmacy was positively associated with all-cause hospital admission, admission for coronary heart disease, admission for stroke, admission for dementia, and emergency department visits. Exposure to PIMs was positively associated with all-cause hospital admission, admission for heart failure (PIMs ≥2), admission for stroke (PIMs ≥3), emergency department visits, bone fracture, constipation, and diarrhea. Conclusion: Chronic polypharmacy and PIMs were prevalent in older adults with diabetes in Chinese communities. Iatrogenic exposure to chronic polypharmacy and PIMs is associated with a higher incidence of different AHOs. This observational evidence highlights the necessity of patient-centered medication reviews for chronic polypharmacy and PIMs use in older patients with diabetes in primary care facilities in China and draws attention to the caution of polypharmacy, especially PIM use in older adults with diabetes in clinical practice.

Keywords: adverse health outcome; clinical practice; diabetes; older; polypharmacy; potentially inappropriate medications.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by the Natural Science Foundation of Guangdong Province, grant No. 2021A1515011193, the Strategic Priority Research Program of Chinese Academy of Sciences, grant No. XDB 38050100, the Shenzhen-Hongkong Join Research Funding, grant No. SGDX20201103095603009, and the National Nature Science Foundation of China, grant No. NSFC61902387.