Comprehensive management of polypharmacy in older patients with diabetes

Park, Kang Seo; Yu, Hea Min

doi:2024.67.7.449

J Korean Med Assoc > Volume 67(7); 2024 > Article

Focused Issue of This Month

Journal of the Korean Medical Association 2024;67(7):449-460.
Published online July 10, 2024.
DOI: https://doi.org/10.5124/jkma.2024.67.7.449

Comprehensive management of polypharmacy in older patients with diabetes

Kang Seo Park

, Hea Min Yu

Division of Endocrinology and Metabolism, Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea

노인 당뇨병에서 다약제 포괄관리

박강서

, 유혜민

을지대학교 의과대학 대전을지대학교병원 내분비대사내과

Correspondence: Hea Min Yu,
Email: hmin00@eulji.ac.kr

Received: 22 March 2024 • Accepted: 14 May 2024

Abstract

Background: Diabetes mellitus is a complex group of chronic metabolic conditions. The incidence of frailty, sarcopenia, geriatric syndrome, and multiple chronic conditions is high in older patients with diabetes, who often require multiple medications for optimal glucose control and treatment of associated chronic complications. Unfortunately, polypharmacy is associated with a high risk of adverse outcomes, such as hypoglycemia, drug-drug interactions, and an increased socioeconomic burden in older adults with diabetes.
Current Concepts: Elderly patients with diabetes are at a high risk for polypharmacy and consequently, a high risk of adverse drug reactions. Polypharmacy is defined as the cumulative use of five or more medications. Comprehensive management and deprescribing are the most important approaches to reduce polypharmacy. Deprescription refers to reduction in or cessation of inappropriate medications.
Discussion and Conclusion: Polypharmacy continues to increase the risk of morbidity and mortality among older adults with diabetes. A comprehensive polypharmacy management and deprescription plan is warranted for significant risk reduction in elderly patients with diabetes.

Key Words: Diabetes mellitus, Aged, Polypharmacy, Comprehensive geriatric assessment, Deprescriptions