open access

Vol 6, No 1 (2017)
Review articles (submitted)
Published online: 2017-06-20
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Pros and cons of polypharmacy in elderly patients with diabetes

Dominik Wojtczak, Jacek Kasznicki, Józef Drzewoski
DOI: 10.5603/DK.2017.0006
·
Pubmed: 12376491
·
Clinical Diabetology 2017;6(1):34-38.

open access

Vol 6, No 1 (2017)
Review articles (submitted)
Published online: 2017-06-20

Abstract

According to the World Health Organization (WHO), polypharmacy is a safe and effective treatment with at least five drugs that is consistent with evidence-based medicine. Unfortunately, too often combination therapies are used without scientific justification. Contemporary available spectrum of hypoglycaemic drugs enables the use of a variety of combinations. Two or, less often, three drugs with different mechanisms of action are used simultaneously. Taking into account the fact that patients with T2DM are likely to have other diseases that require multiple medications, the potential risk of clinically relevant drug interactions is high. This may, inter alia, undesirably affect the daily fluctuations of glycaemia with the serious consequences of this phenomenon. The risk of severe hypoglycaemia or hyperglycaemia is especially related to elderly patients. In this group polypragmasy is much more common than in the same age group with normal carbohydrate metabolism. The aim of this paper is to discuss the phenomenon of polypragmasy with particular emphasis on its occurrence in elderly patients with T2DM.

Abstract

According to the World Health Organization (WHO), polypharmacy is a safe and effective treatment with at least five drugs that is consistent with evidence-based medicine. Unfortunately, too often combination therapies are used without scientific justification. Contemporary available spectrum of hypoglycaemic drugs enables the use of a variety of combinations. Two or, less often, three drugs with different mechanisms of action are used simultaneously. Taking into account the fact that patients with T2DM are likely to have other diseases that require multiple medications, the potential risk of clinically relevant drug interactions is high. This may, inter alia, undesirably affect the daily fluctuations of glycaemia with the serious consequences of this phenomenon. The risk of severe hypoglycaemia or hyperglycaemia is especially related to elderly patients. In this group polypragmasy is much more common than in the same age group with normal carbohydrate metabolism. The aim of this paper is to discuss the phenomenon of polypragmasy with particular emphasis on its occurrence in elderly patients with T2DM.

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Keywords

polifarmacotheraphy, polypragmasia, diabetes mellitus, polifarmacotheraphy in diabetes

About this article
Title

Pros and cons of polypharmacy in elderly patients with diabetes

Journal

Clinical Diabetology

Issue

Vol 6, No 1 (2017)

Pages

34-38

Published online

2017-06-20

DOI

10.5603/DK.2017.0006

Pubmed

12376491

Bibliographic record

Clinical Diabetology 2017;6(1):34-38.

Keywords

polifarmacotheraphy
polypragmasia
diabetes mellitus
polifarmacotheraphy in diabetes

Authors

Dominik Wojtczak
Jacek Kasznicki
Józef Drzewoski

References (25)
  1. Nobili A, Licata G, Salerno F, et al. SIMI Investigators. Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study. Eur J Clin Pharmacol. 2011; 67(5): 507–519.
  2. Wald DS, Law M, Morris JK, et al. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med. 2009; 122(3): 290–300.
  3. Yusuf S. Two decades of progress in preventing vascular disease. Lancet. 2002; 360(9326): 2–3.
  4. Webster R, Patel A, Selak V, et al. SPACE Collaboration. Effectiveness of fixed dose combination medication ('polypills') compared with usual care in patients with cardiovascular disease or at high risk: A prospective, individual patient data meta-analysis of 3140 patients in six countries. Int J Cardiol. 2016; 205: 147–156.
  5. Schäfer I, von Leitner EC, Schön G, et al. Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions. PLoS One. 2010; 5(12): e15941.
  6. Wang R, Chen L, Fan Li, et al. Incidence and Effects of Polypharmacy on Clinical Outcome among Patients Aged 80+: A Five-Year Follow-Up Study. PLoS One. 2015; 10(11): e0142123.
  7. Neumann-Podczaska A, Wawszyk K, Wieczorkowska-Tobis K. Zagrożenia sprawności funkcjonalnej osób starszych wynikające z samoleczenia lekami przeciwbólowymi. Przegląd Lekarski 2012; 69. ; 10: 773–776.
  8. Cruz-Jentoft AJ, Gutiérrez B. Upper age limits in studies submitted to a research ethics committee. Aging Clin Exp Res. 2010; 22(2): 175–178.
  9. Ballentine NH. Polypharmacy in the elderly: maximizing benefit, minimizing harm. Crit Care Nurs Q. 2008; 31(1): 40–45.
  10. Sobów T. Hazards of polypharmacy in neurology. Postępy Nauk Medycznych. 2010; 23(6): 483–491.
  11. Flaherty JH, Takahashi R. The use of complementary and alternative medical therapies among older persons around the world. Clin Geriatr Med. 2004; 20(2): 179–200, v.
  12. Lund BC, Steinman MA, Chrischilles EA, et al. Beers criteria as a proxy for inappropriate prescribing of other medications among older adults. Ann Pharmacother. 2011; 45(11): 1363–1370.
  13. Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010; 107(31-32): 543–551.
  14. Machalski P, Koziarska-Rościszewska M. Zasady bezpiecznej farmakoterapii osób w starszym wieku - lista PRISCUS. Medycyna Rodzinna. 2013; 3: 106–111.
  15. Kuijpers M, Marum Rv, Egberts A, et al. Relationship between polypharmacy and underprescribing. British Journal of Clinical Pharmacology. 2008; 65(1): 130–133.
  16. Fernández C, Formiga F, Camafort M, et al. Erratum: Antithrombotic treatment in elderly patients with atrial fibrillation: a practical approach. BMC Cardiovascular Disorders. 2015; 15(1).
  17. Breuker C, Abraham O, di Trapanie L, et al. Patients with diabetes are at high risk of serious medication errors at hospital: Interest of clinical pharmacist intervention to improve healthcare. Europ J Inter Med. 2017; 38: 38–45.
  18. Singh B, Mourya A, Sah SP, et al. Protective effect of losartan and ramipril against stress induced insulin resistance and related complications: Anti-inflammatory mechanisms. Eur J Pharmacol. 2017; 801: 54–61.
  19. Sattar NA, Ginsberg H, Ray K, et al. The use of statins in people at risk of developing diabetes mellitus: evidence and guidance for clinical practice. Atheroscler Suppl. 2014; 15(1): 1–15.
  20. Jones M, Tett S, Peeters GM, et al. New-Onset Diabetes After Statin Exposure in Elderly Women: The Australian Longitudinal Study on Women's Health. Drugs Aging. 2017; 34(3): 203–209.
  21. Semenkovich K, Brown ME, Svrakic DM, et al. Depression in type 2 diabetes mellitus: prevalence, impact, and treatment. Drugs. 2015; 75(6): 577–587.
  22. Teifer SJ. Fluoroquinolone antibiotics and type 2 diabetes mellitus Med Hypotheses. 2014 Sep. ; 83(3): 263–9.
  23. Rena G, Sakamoto K. Salicylic acid: old and new implications for the treatment of type 2 diabetes? Diabetol Int. 2014; 5(4): 212–218.
  24. Mays HV, Setter SM. P Drug-induced glucose alternations part 1: Drug-induced hypoglycemia Diabetes spectrum 2011;Vol. 24, no. ; 3: 171.
  25. Lipska KJ, Krumholz H, Soones T, et al. Polypharmacy in the Aging Patient: A Review of Glycemic Control in Older Adults With Type 2 Diabetes. JAMA. 2016; 315(10): 1034–1045.

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