Polypharmacy and Pharmacological Treatment of Diabetes in Older Individuals: A Population-Based Study in Quebec, Canada

Abstract

Our objectives were to describe the use of pharmacological treatments in older adults with diabetes and to identify the factors associated with the use of a combination of hypoglycemic, antihypertensive and lipid-lowering agents. Using the Quebec Integrated Chronic Disease Surveillance System, we conducted a population-based cohort study among individuals aged 66-75 years with diabetes in 2014-2015. We described the number of medications and the classes of medications used and calculated the proportion of individuals using at least one medication from each of these classes: hypoglycemics, antihypertensives and lipid-lowering agents. We identified the factors associated with the use of this combination of treatments by performing robust Poisson regressions. The 146,710 individuals used an average of 12 (SD 7) different medications, mostly cardiovascular (91.3% of users), hormones, including hypoglycemic agents (84.5%), and central nervous system medications (79.8%). The majority of individuals (59%) were exposed to the combination of treatments and the factor most strongly associated was the presence of cardiovascular comorbidities (RR: 1.29; 99% CI: 1.28-1.31). Older individuals with diabetes are exposed to a large number of medications. While the use of the combination of treatments is significant and could translate into cardiovascular benefits at the population level, the potential risk associated with polypharmacy needs to be documented. * The combination of treatments includes at least one of each of the following drug classes:

Sex-specific medication trajectories in older adults newly diagnosed with diabetes

“…To identify individuals newly diagnosed with diabetes, we used a validated case definition (sensitivity = 94.6% and positive predictive value = 87.9%) routinely used in surveillance in Canada. 5 , 31 Subjects with two physicians claims with a diagnosis of diabetes (International Classification of Diseases - 9th version, ICD-9: 250, ICD-10: E10-E14) within two years or one hospitalization with such a diagnosis code were considered as having diabetes. 27 The date of diagnosis was the earliest of the second date of the physician claims, or the date of hospital discharge.…”

“…Indeed, the average number of medications used by older adults with diabetes in Quebec in 2014 was 12. 5 As a result, most individuals with diabetes are exposed to polypharmacy, which is most commonly defined as the concomitant use of at least five medications. 6 , 7 However, polypharmacy has been associated with adverse outcomes, such as increased falls, hospitalizations, and mortality.…”