The Relation Between Polypharmacy,Potentially Inappropriate Medications,Organ Function,and Quality of Life in Elderly Patients with Type 2 Diabetes

Abstract

Objective: To determine the prevalence of polypharmacy, potentially inappropriate medications (PIMs) and potentially serious clinically relevant DDIs and to determine the association of polypharmacy with PIMs, potentially serious clinically relevant DDI, kidney function, liver function, serum electrolytes, and quality of life (QoL) in old patients with type 2 diabetes mellitus (T2DM). Methods: A cross-sectional study was performed among 136 patients (aged ≥ 65) with T2DM in the Center of Diabetes and Endocrine Diseases in Sulaimani, Iraq. A clinical pharmacist used an interview-based questionnaire to collect data. Blood samples were obtained to measure HbA1c, fasting blood glucose, creatinine, urea, AST, ALT, and potassium. STOPP criteria version 3 was used to identify PIMs, while, DDIs were checked using the Medscape interaction database. Results: In this study, the prevalence of polypharmacy was 55.88%. Patients on polypharmacy exhibited higher BMI 29.60 ± 4.220 (P-value = 0.037), longer diabetes duration 14.24 ± 6.464 (P-value = 0.0001), more comorbidities 100% (P-value = 0.0001), more diabetes complications 93.4% (P-value = 0.006), and greater use of chronic medications 100% (P-value = 0.0001) compared to those without polypharmacy. Among the participants, 64.7% had PIMs, with 64% linked to the endocrine system. Additionally, 14% experienced potentially serious clinically relevant DDIs, mostly due to interaction between aspirin and ACE inhibitors 47.8%. The prevalence of PIMs 73.7% (P-value = 0.019) and potentially serious clinically relevant DDIs 25% (P-value = 0.0001) respectively were higher in patients with polypharmacy compared to those without polypharmacy. Furthermore, polypharmacy was correlated with lower QoL index scores 0.221 ± 0.411 (P-value = 0.002), lower mean VAS scores 59.54 ± 7.83 (P-value = 0.028), and high serum K⁺ 4.81 ± 0.545 (P-value = 0.022). However, no significant differences in kidney function tests (GFR and urea) and liver function tests (AST and ALT), were seen between the two groups. Conclusion: The findings highlight a high prevalence of PIMs and potentially serious DDIs in patients on polypharmacy. Furthermore, polypharmacy is associated with poorer QoL outcomes in older patients with T2DM, emphasizing the need for careful medication review and management in this population.