Polypharmacy in elderly patients with type 2 diabetes receiving oral antidiabetic treatment
Tóm tắt
Polypharmacy in older diabetics can have detrimental effects linked to poor adherence and the risk of drug interaction or more serious/frequent side effects. The aim of this study was to identify the characteristics associated with polypharmacy in a cohort of elderly diabetic patients being treated with oral hypoglycemic agents. The study population consisted of 1342 diabetic patients consecutively enrolled in 57 diabetes centers in Italy participating in the METABOLIC Study. Patients meeting the following inclusion criteria were enrolled: diagnosis of type 2 diabetes mellitus, age ≥65 years, and receiving oral antidiabetic treatment. Data concerning diabetes duration and complications, the medications the patients were taking, and the number of hypoglycemic events were registered. Multidimensional impairment was assessed using the Multidimensional Prognostic Index. The mean age of the participants was 73.3 ± 5.5 years. Polypharmacy, defined as being prescribed contemporaneously at least five drugs, was found in 57.1 % of the study population. According to a multivariable logistic model, the female gender was significantly associated with polypharmacy, as were living in Northern Italian regions, diabetes duration longer than 4 years, and having a body mass index ≥30 kg/m2. Comorbidities, diabetes complications, a better cognitive performance on the Short Portable Mental Status Questionnaire, and being malnourished/at risk of malnourishment according to the mini nutritional assessment were associated with polypharmacy. Polypharmacy, a condition that may lead to many potential detrimental outcomes in older diabetic subjects, was significantly associated with some risk factors that may be useful to identify subjects at risk.
Tài liệu tham khảo
Dardano A, Penno G, Del Prato S, Miccoli R (2014) Optimal therapy of type 2 diabetes: a controversial challenge. Aging (Albany NY) 6(3):187–206
Selvin E, Coresh J, Brancati FL (2006) The burden and treatment of diabetes in elderly individuals in the US. Diabetes Care 29(11):2415–2419
Ubink-Veltmaat LJ, Bilo HJ, Groenier KH, Houweling ST, Rischen RO, Meyboom-de Jong B (2003) Prevalence, incidence and mortality of type 2 diabetes mellitus revisited: a prospective population-based study in The Netherlands (ZODIAC-1). Eur J Epidemiol 18(8):793–800
Emslie-Smith A, Dowall J, Morris A (2003) The problem of polypharmacy in type 2 diabetes. Br J Diabetes Vasc Dis 3(1):54–56
Bauer S, Nauck MA (2014) Polypharmacy in people with type 1 and type 2 diabetes is justified by current guidelines—a comprehensive assessment of drug prescriptions in patients needing inpatient treatment for diabetes-associated problems. Diabet Med 31(9):1078–1085
Chelliah A, Burge MR (2004) Hypoglycaemia in elderly patients with diabetes mellitus: causes and strategies for prevention. Drugs Aging 21(8):511–530
Peron EP, Ogbonna KC, Donohoe KL (2015) Antidiabetic medications and polypharmacy. Clin Geriatr Med 31(1):17–27. doi:10.1016/j.cger.2014.08.017
Sergi G, De Rui M, Sarti S, Manzato E (2011) Polypharmacy in the elderly: can comprehensive geriatric assessment reduce inappropriate medication use? Drugs Aging 28(7):509–518
Maggi S, Noale M, Pilotto A, Tiengo A, Cavallo Perin P, Crepaldi G, for the Metabolic Working Group (2013) The METABOLIC Study: multidimensional assessment of health and functional status in older patients with type 2 diabetes taking oral antidiabetic treatment. Diabetes Metab 39:236–243
Pilotto A, Noale M, Maggi S, Addante F, Tiengo A, Perin PC, Rengo G, Crepaldi G (2014) Hypoglycemia is independently associated with multidimensional impairment in elderly diabetic patients. Biomed Res Int 2014:906103
Pilotto A, Ferrucci L, Franceschi M, D’Ambrosio LP, Scarcelli C, Cascavilla L, Paris F, Placentino G, Seripa D, Dallapiccola B, Leandro G (2008) Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 11(1):151–161
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function. JAMA 185:914–919
Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186
Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23:433–441
Bliss MR, McLaren R, Exton-Smith AN (1966) Mattresses for preventing pressure sores in geriatric patients. Mon Bull Minist Health Public Health Lab Serv 25:238–268
Conwell Y, Forbes NT, Cox C, Caine ED (1993) Validation of a measure of physical illness burden at autopsy: the Cumulative Illness Rating Scale. J Am Geriatr Soc 41:38–41
Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S et al (1999) The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 15:116–122
Gallucci M, Battistella G, Bergamelli C, Spagnolo P, Mazzuco S, Carlini A, Di Giorgi E, Boldrini P, Pilotto A (2014) Multidimensional prognostic index in a cognitive impairment outpatient setting: mortality and hospitalizations. The treviso dementia (TREDEM) study. J Alzheimers Dis 42:1461–1468
Pilotto A, Gallina P, Fontana A, Sancarlo D, Bazzano S, Copetti M, Maggi S, Paroni G, Marcato F, Pellegrini F, Donato D, Ferrucci L (2013) Development and validation of a Multidimensional Prognostic Index for mortality based on a standardized multidimensional assessment schedule (MPI-SVaMA) in community-dwelling older subjects. J Am Med Dir Assoc 14:287–292
Blanco-Reina E, Ariza-Zafra G, Ocaña-Riola R, León-Ortíz M, Bellido-Estévez I (2015) Optimizing elderly pharmacotherapy: polypharmacy vs. undertreatment. Are these two concepts related? Eur J Clin Pharmacol 71(2):199–207
Payne RA, Avery AJ (2011) Polypharmacy: one of the greatest prescribing challenges in general practice. Br J Gen Pract 61(583):83–84
Rochon PA, Gurwitz JH (1997) Optimising drug treatment for elderly people: the prescribing cascade. BMJ 315(7115):1096–1099
Venturini CD, Engroff P, Ely LS, Zago LF, Schroeter G, Gomes I, De Carli GA, Morrone FB (2011) Gender differences, polypharmacy, and potential pharmacological interactions in the elderly. Clinics (Sao Paulo) 66(11):1867–1872
Jyrkkä J, Mursu J, Enlund H, Lönnroos E (2012) Polypharmacy and nutritional status in elderly people. Curr Opin Clin Nutr Metab Care 15(1):1–6