Polypharmacy increases mortality and MI in elderly with diabetes

Al-Musawe L, Martins P, 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 Pract 155: 107804

• Polypharmacy is common in older people with type 2 diabetes, as they often have comorbid conditions that require treatment. Polypharmacy can be associated with adverse outcomes, such as increased risk of hypoglycaemia, making patient management complex.
• The authors of this systematic review searched four databases for papers looking at polypharmacy and adverse outcomes (mortality, glycaemic control, macrovascular complications, hospitalisation, falls, potentially inappropriate prescribing and drug–drug interactions) in older people with type 2 diabetes.
• Sixteen studies were identified that included over 1.2 million patients in total. Three of these studies were used in a meta-analysis.
• Some but not all studies found polypharmacy to be associated with adverse outcomes, leading the authors to question whether polypharmacy is a marker of inappropriate medicines usage or underprescribing leading to the underuse of appropriate medicines and increased risk of adverse health outcomes.
• Polypharmacy was found to be associated with stroke and with hospitalisation and was significantly associated with both myocardial infarction and risk of death.
• Appropriate patient monitoring and the development of interventions to improve medication use were advocated by the authors. 

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