Polypharmacy as a Risk Factor in the Treatment of Type 2 Diabetes

Abstract

The desire to take medicine is perhaps the greatest feature which distinguishes man from animals. — Sir William Osler (1849–1919)1 Polypharmacy is a term that has been used in health care for decades. In conventional use, it has meant the concurrent use of multiple medications in the same patient. However, this definition understates the potential for harm that polypharmacy may pose to the patient. Other definitions have appeared in the medical literature that put the problem of polypharmacy in a broader perspective. One defines polypharmacy as the “prescription, administration, or use of more medications than are clinically indicated, or when a medical regimen includes at least one unnecessary medication.”2–5 However, polypharmacy may be unavoidable, given that multiple drug therapy has become the standard of care in most chronic conditions.6 The comorbidities of diabetes commonly include hypertension, dyslipidemia, depression, and coagulopathies, each of which may require one or more drugs for adequate control. Add to this other conditions that often accompany diabetes, such as hypothyroidism, heart failure, and osteoporosis, and the total number of possible medications needed becomes significant. Polypharmacy is inevitable when treating a common chronic condition such as diabetes, given the large number of treatment options now available. The potential for polypharmacy will continue to increase with time, as additional therapeutic options become available. Before the approval of metformin in the United States in 1995, only insulin and the sulfonylureas were available for the treatment of diabetes. Now, there are five classes of oral agents, three rapid-acting insulin analogs, and two long-acting analogs, as well as the “traditional” insulins. The emergence of other forms of insulin (inhaled, topical patches), the incretin gut hormones, newer mixed peroxisome proliferator–activated receptor-α and -γ agonists, a synthetic amylin analog, and still more agents to come will increase opportunities …