Polypharmacy increases complications and mortality in older people

Al-Musawe L, Martins AP, Raposo JF, Torre C (2019) The association between polypharmacy and adverse health consequences in elderly type 2 diabetes mellitus patients; a systematic review and meta-analysis. Diabetes Res Clin Pract155: 107804

• Older people with diabetes are more likely to have associated comorbidities and are frequently prescribed multiple medications as part of tailored treatment regimens. Polypharmacy can increase the risk of hypoglycaemia and drug­–drug interactions as well as reducing medication adherence and quality of life; therefore guidelines recommend practitioners consider reducing or avoiding medications when safe to do so.
• The authors of this paper examined published literature on the association between polypharmacy and adverse health consequences in older people with type 2 diabetes. 
• Three of the 16 observational and interventional studies that considered links between polypharmacy and all-cause mortality, glycaemic control, macrovascular complications, hospitalisation, potentially inappropriate prescribing, drug–drug interactions and falls in people aged ≥65 with type 2 diabetes were included in the meta-analysis.
• Polypharmacy was found to have a significant association with myocardial infarction and all-cause mortality. It was also associated with an increased risk of hospitalisation and stroke.
• The prevalence of inappropriate prescribing in polypharmacy patients ranged from 23% to 79%.
• The authors concluded that polypharmacy increases the risk of death, macrovascular complications and hospitalisation. They advocated the implementation of appropriate monitoring, including laboratory testing and patient education, in addition to interventions to optimise benefit versus harm when prescribing for older people with diabetes.

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