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. 2021 Apr;38(4):e14406.
doi: 10.1111/dme.14406. Epub 2020 Oct 17.

Characteristics associated with polypharmacy in people with type 2 diabetes: the Dutch Diabetes Pearl cohort

S van Oort  1   2 , F Rutters  1 , M F Warlé-van Herwaarden  3 , M T Schram  4 , C D Stehouwer  4 , C J Tack  5 , E J Abbink  5 , B H Wolffenbuttel  6 , M M van der Klauw  6 , J H DeVries  7 , S E Siegelaar  7 , E J Sijbrands  8 , B Özcan  8 , H W de Valk  9 , B Silvius  9 , M A Schroijen  10 , I M Jazet  10 , A J van Ballegooijen  1   11 , J W J Beulens  1   12 , P J Elders  13 , C Kramers  2 ; Diabetes Pearl from the Parelsnoer Initiative
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Characteristics associated with polypharmacy in people with type 2 diabetes: the Dutch Diabetes Pearl cohort

S van Oort et al. Diabet Med. 2021 Apr.

Abstract

Aim: To describe the prevalence and characteristics of polypharmacy in a Dutch cohort of individuals with type 2 diabetes.

Methods: We included people with type 2 diabetes from the Diabetes Pearl cohort, of whom 3886 were treated in primary care and 2873 in academic care (secondary/tertiary). With multivariable multinomial logistic regression analyses stratified for line of care, we assessed which sociodemographic, lifestyle and cardiometabolic characteristics were associated with moderate (5-9 medications) and severe polypharmacy (≥10 medications) compared with no polypharmacy (0-4 medications).

Results: Mean age was 63 ± 10 years, and 40% were women. The median number of daily medications was 5 (IQR 3-7) in primary care and 7 (IQR 5-10) in academic care. The prevalence of moderate and severe polypharmacy was 44% and 10% in primary care, and 53% and 29% in academic care respectively. Glucose-lowering and lipid-modifying medications were most prevalent. People with severe polypharmacy used a relatively large amount of other (i.e. non-cardiovascular and non-glucose-lowering) medication. Moderate and severe polypharmacy across all lines of care were associated with higher age, low educational level, more smoking, longer diabetes duration, higher BMI and more cardiovascular disease.

Conclusions: Severe and moderate polypharmacy are prevalent in over half of people with type 2 diabetes in primary care, and even more in academic care. People with polypharmacy are characterized by poorer cardiometabolic status. These results highlight the significance of polypharmacy in type 2 diabetes.

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Figures

FIGURE 1
FIGURE 1
Multivariable association models of sociodemographic, lifestyle and cardiometabolic characteristics with level of polypharmacy in 6759 people of the Diabetes Pearl cohort, stratified by line of care. No polypharmacy was the reference category in both analyses. The results are presented as adjusted odds ratios (ORs) with 95% confidence intervals (95% CI) of the multivariable multinomial logistic regression analysis with imputed data. Refer to Table S3 for the exact numbers. *HbA1c categories: <54 mmol/mol (< 7.1%), 54–64 mmol/mol (7.1–8.0%), >64 mmol/mol (> 8.0%). CVD, cardiovascular disease
FIGURE 2
FIGURE 2
Overview of the total number of medications used in the Diabetes Pearl cohort, stratified by line of care, polypharmacy level, main medication types and level 3 ATC codes. No polypharmacy, 0–4 medications; moderate polypharmacy, 5–9 medications; severe polypharmacy, ≥10 medications). ATC, Anatomical Therapeutic Chemical classification
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