Antidiabetic Medications and Polypharmacy

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Key points

  • Polypharmacy, or the use of multiple medications, is common in older adults and more prevalent in older adults with diabetes.

  • Medications used to treat diabetes and its complications may be associated with falls, fractures, weight changes, cognitive changes, heart disease, and urinary incontinence.

  • Shared decision-making should be implemented to ensure appropriate goals of care for older adults with diabetes.

Factors contributing to polypharmacy in older adults with diabetes

Management of hyperglycemia, microvascular complications (eg, diabetic nephropathy, neuropathy, and retinopathy) and macrovascular complications (eg, coronary artery disease, peripheral arterial disease, stroke), geriatric syndromes associated with diabetes (eg, cognitive impairment, falls, urinary incontinence), and adverse drug events contribute to an increased number of medications among older adults with diabetes. Quality improvement measures and pay-for-performance initiatives aimed at

Risks of antidiabetic medications in older adults

Although nonpharmacologic interventions are important in the management of diabetes, medications are a mainstay of therapy. It is particularly important when treating older adults with diabetes that the risks and benefits of pharmacologic interventions are weighed and discussed with patients and their caregivers to allow for shared decision-making. What makes treating diabetes in older adults even more complex is that the risks versus benefits for an individual are rarely clear from the

Merging concepts with practice

Managing diabetes in an older adult requires careful consideration of comorbidities, medications, and physiologic changes. In practice, providers are often faced with pacifying measures that are disease-specific or guideline-based. Older adult patients are not easily grouped by presentation, health status, or a single disease, making attainment of generalized goals more challenging.25 A variety of guidelines exist for the management of diabetes; however, their focus on a single disease limits

Patient-centered care and quality of life

Given the intricacy and variability of diabetes management in the geriatric population, patient involvement and shared decision-making are essential. Positive outcomes in this patient population rely heavily on the patient’s or caregiver’s ability to manage multiple chronic diseases and medications on a daily basis. Patient-centered care is defined as an approach to “providing care that is respectful of and responsive to individual preferences, needs, and values and ensuring the patient values

Summary

Polypharmacy, or the use of multiple medications, is a common concern in older adults with diabetes. Age, comorbidities, and microvascular and macrovascular complications of diabetes may further complicate diabetes management in older adults. Moreover, older adults may be more sensitive to potentially serious adverse effects of antidiabetic medications, including cognitive changes. Diabetic care in the elderly should not focus on any one of these aspects alone; instead, a comprehensive approach

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    • Polypharmacy and bone fracture risk in patients with type 2 diabetes: The Fukuoka Diabetes Registry

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      The estimated prevalence of polypharmacy among patients with type 2 diabetes was reported to range from 57% to 84% [7]. Polypharmacy was shown to be associated with an increased risk of adverse drug events [8], drug–drug interactions, and prescribing cascades [9], resulting in negative outcomes such as incident falls, poor quality of life, and increased healthcare costs [10]. Although some studies have shown an association between polypharmacy and bone fracture risk in the general population [11–16], there is limited epidemiological evidence to date.

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      It may be because patients with diabetes are at higher risk of receiving polypharmacy than patiens without diabetes. So, addicted patiens with diabetes have increased risks of adverse drug events [23]. In this regard, Baillargeon et al. indicated that COVID-19 patients with substance use are at greater risk for adverse outcomes [24].

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