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Polypharmacy in elderly patients with type 2 diabetes receiving oral antidiabetic treatment

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Abstract

Aim

Polypharmacy in older diabetics can have detrimental effects linked to poor adherence and the risk of drug interaction or more serious/frequent side effects. The aim of this study was to identify the characteristics associated with polypharmacy in a cohort of elderly diabetic patients being treated with oral hypoglycemic agents.

Methods

The study population consisted of 1342 diabetic patients consecutively enrolled in 57 diabetes centers in Italy participating in the METABOLIC Study. Patients meeting the following inclusion criteria were enrolled: diagnosis of type 2 diabetes mellitus, age ≥65 years, and receiving oral antidiabetic treatment. Data concerning diabetes duration and complications, the medications the patients were taking, and the number of hypoglycemic events were registered. Multidimensional impairment was assessed using the Multidimensional Prognostic Index.

Results

The mean age of the participants was 73.3 ± 5.5 years. Polypharmacy, defined as being prescribed contemporaneously at least five drugs, was found in 57.1 % of the study population. According to a multivariable logistic model, the female gender was significantly associated with polypharmacy, as were living in Northern Italian regions, diabetes duration longer than 4 years, and having a body mass index ≥30 kg/m2. Comorbidities, diabetes complications, a better cognitive performance on the Short Portable Mental Status Questionnaire, and being malnourished/at risk of malnourishment according to the mini nutritional assessment were associated with polypharmacy.

Conclusions

Polypharmacy, a condition that may lead to many potential detrimental outcomes in older diabetic subjects, was significantly associated with some risk factors that may be useful to identify subjects at risk.

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Acknowledgments

The METABOLIC Study was supported by a research Grant from Sigma-Tau Industrie Farmaceutiche Riunite, Pomezia (Roma). The authors wish to thank Linda Inverso Moretti for reviewing the English version of this manuscript.

Author information

Author notes

    Authors and Affiliations

    1. CNR - Institute of Neuroscience, Aging Branch, Via Giustiniani 2, 35128, Padua, Italy

      Marianna Noale, Gaetano Crepaldi & Stefania Maggi

    2. Department of Medicine, University of Padua, Padua, Italy

      Nicola Veronese & Antonio Tiengo

    3. Diabetology Unit, University of Turin, Turin, Italy

      Paolo Cavallo Perin

    4. Geriatrics Unit, Azienda ULSS, 16, S. Antonio Hospital, Padua, Italy

      Alberto Pilotto

    Authors
    1. Marianna Noale
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    2. Nicola Veronese
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    3. Paolo Cavallo Perin
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    4. Alberto Pilotto
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    5. Antonio Tiengo
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    6. Gaetano Crepaldi
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    7. Stefania Maggi
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    Corresponding author

    Correspondence to Marianna Noale.

    Ethics declarations

    Conflict of interest

    The authors declare that they have no conflict of interest.

    Ethical standard

    The study was approved by ethics review committees of each participating center.

    Human and animal rights

    All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

    Informed consent

    Informed consent was obtained from all patients for being included in the study.

    Additional information

    Managed by Massimo Porta.

    Marianna Noale and Nicola Veronese have contributed equally to the study.

    Metabolic Working Group is listed in the section “Appendix”.

    Electronic supplementary material

    Below is the link to the electronic supplementary material.

    Supplementary material 1 (PDF 9 kb)

    Appendix: Metabolic Working Group

    Appendix: Metabolic Working Group

    Andrea Corsi, Aglioloro Alberto (Sampierdarena—GE); Allochis Gabriele (Novara); Aricò Concetta Nadia (Belluno); Balbo Marcella (Alessandria); Marangoni Alberto, Balzano Sara (Bassano del Grappa, VI); Battisti Basilio (Rieti); Testa Ivano, Brandoni Gabriele (Ancona); Bruno Alberto, Degiovanni Mariella (Torino); Buzzetti Raffaella, Foffi Chiara (Latina); Calatola Pasqualino (Salerno); Cantarella Santi Antonio (Canicattì—AG); Rondena Maurizio, Cimpanelli Maria Grazia (Legnano—MI); Confortin Loris (Castelfranco Veneto, TV); Consoli Agostino, Baldassarre Maria (Pescara); Invitti Cecilia, Conti Antonio (Milano); Del Prato Stefano, Crisci Isabella (Pisa); Derosa Giuseppe, Maffioli Pamela (Pavia); Devangelio Eleonora (Taranto); Di Bartolo Paolo (Ravenna);Ruggeri Patrizia, Di Lembo Sergio (Cremona); Di Mauro Maurizio, Battiato Rosario (Catania); Farci Fernando (Quartu S. Elena—CA); Fisicaro Michela (Nicosia—EN); Pontiroli Antonio, Folini Laura (Milano); Gargiulo Anna, Vinciguerra Antonio (Caserta); Giorgino Francesco, Laviola Luigi (Bari); Clementina Cazzalini, Guerini Stelio (Crema); Tonolo Giancarlo, Iwniszyn Dominika (Olbia); Lambiase Claudio (Mercato San Severino—SA); Leotta Sergio (Roma); Mangeri Felice (Brescia); Mangili Ruggero (Seriate—BG); Mattiuzzo Claudio (Tivoli—RM); Mollo Francesco (Rovigo); Novara Francesca, Gucciardi Paolo (Paceco—TP); Orsi Emanuela, Palmieri Eva (Milano); Pacifico Adolfo Arturo, Burruni Anna (Sassari); Pagani Giorgio, Albizzi Monica (Bergamo); Pasquini Cristina (Livorno); Cavallo Perin Paolo, Perotto Massimo (Torino); Piccolo Patrizia (Cosenza); Pilotto Alberto, D’Ambrosio Piero (San Giovanni Rotondo—FG); Maolo Gabriele, Polenta Barbara (Macerata); Purrello Francesco, Tomaselli Tania (Catania); Tardio Michele Sergio, Quarantelli Cristina (Parma); Ragusa Giorgio Salvatore (Scicli—RG); Borzì Vito, Rapisardi Riccardo (Catania); Richini Donata (Brescia); Rosco Maura (Bari); Serra Rosalia (Lecce): Marchesini Reggiani Giulio, Soverini Valentina (Bologna); Tiengo Antonio (Padova); Tomasi Franco (Ferrara); De Angelis Massimiliano, Turco Antonio (Perugia); Tolaini Patricia, Vangucci Silverio (Castelnuovo Garfagnana—LU); Zavaroni Ivana (Parma).

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    Noale, M., Veronese, N., Cavallo Perin, P. et al. Polypharmacy in elderly patients with type 2 diabetes receiving oral antidiabetic treatment. Acta Diabetol 53, 323–330 (2016). https://doi.org/10.1007/s00592-015-0790-4

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    • DOI: https://doi.org/10.1007/s00592-015-0790-4

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