- •
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.
Antidiabetic Medications and Polypharmacy
Section snippets
Key points
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
References (45)
- et al.
European Diabetes Working Party for older people 2011 clinical guidelines for type 2 diabetes mellitus. Executive summary
Diabetes Metab
(2011) - et al.
The duration of diabetes affects the response to intensive glucose control in type 2 subjects: the VA diabetes trial
J Diabetes Complications
(2011) - Slone Epidemiology Center. Patterns of medication use in the United States. Available at:...
Standards of medical care in diabetes – 2014
Diabetes Care
(2014)- et al.
Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance
JAMA
(2005) - et al.
Factors contributing to medication noncompliance in elderly public housing tenants
Drug Intell Clin Pharm
(1986) - et al.
Communicating information about drug safety
BMJ
(2006) - et al.
Risk factors for adverse drug events among nursing home residents
Arch Intern Med
(2001) - et al.
Diabetes in older adults: a consensus report
J Am Geriatr Soc
(2012) - et al.
Optimising drug treatment for elderly people: the prescribing cascade
BMJ
(1997)
Strategies for prevention of medication-related falls in the elderly
Consult Pharm
Diabetes and risk of hospitalized injury among older adults
Diabetes Care
Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities
Diabetes Care
2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults
J Am Geriatr Soc
Diabetes medications related to an increased risk of falls and fall-related morbidity in the elderly
Ann Pharmacother
A cohort study of thiazolidinediones and fractures in older adults with diabetes
J Clin Endocrinol Metab
Thiazolidinedione use and the longitudinal risk of fractures in patients with type 2 diabetes mellitus
J Clin Endocrinol Metab
The relationship between weight loss and all-cause mortality in older men and women with and without diabetes mellitus: the Rancho Bernardo study
J Am Geriatr Soc
Diabetes treatment, part 2: oral agents for glycemic management
Clin Diabetes
Bodyweight changes associated with antihyperglycaemic agents in type 2 diabetes mellitus
Drug Saf
Increased risk of cognitive impairment in patients with diabetes is associated with metformin
Diabetes Care
Cited by (68)
Association between medication regimen complexity and glycemic control among patients with type 2 diabetes
2023, Journal of the American Pharmacists AssociationPolypharmacy in the Hospitalized Older Adult: Considerations for Safe and Effective Treatment
2022, Clinics in Geriatric MedicinePolypharmacy and bone fracture risk in patients with type 2 diabetes: The Fukuoka Diabetes Registry
2021, Diabetes Research and Clinical PracticeCitation Excerpt :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.
Geriatrics on beers criteria medications at risk of adverse drug events using real-world data
2021, International Journal of Medical InformaticsPredictors of COVID-19 related death in diabetes patients: A case-control study in Iran
2021, Diabetes and Metabolic Syndrome: Clinical Research and ReviewsCitation Excerpt :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].
Medication-Related Hospital Admissions and Emergency Department Visits in Older People with Diabetes: A Systematic Review
2024, Journal of Clinical Medicine