Polypharmacy and Comorbidity Status in the Treatment of Type 2 Diabetic Patients Attending Tertiary Care Hospitals

Authors

  • Muhammad Hassan Raza University of Lahore, Islamabad Campus, Pakistan.
  • Saira Shahnaz Department of Pharmacy Practice, Faculty of Pharmacy, Nazeer Hussain University, Karachi, Sindh, Pakistan.
  • Sidra Riaz Scientific Adviser, Ministry of Science and Technology, Islamabad, Pakistan.
  • Muhammad Zain Ul Abideen National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Punjab, Pakistan.
  • Ahsan Iqbal Khan Luqmani HITEC Institute of Medical Sciences, Taxila Cantt, Rawalpindi, Punjab, Pakistan.
  • Muhammad Amjad Hayat Faculty of Pharmacy, Gomal University, Dera Ismail Khan, KP, Pakistan.
  • Muhammad Arsalan Murtaza Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan.
  • Sabah Mansoor Department of Allied Sciences, University of Home Economics, Lahore, Punjab, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v4i3.2980

Keywords:

Polypharmacy, Comorbidity, Drug Interactions, Adverse Drug Reactions (ADRs), Dyslipidemia.

Abstract

Aim: Diabetes is a lifelong disorder, which is markedly affected by day-to-day variations in diet, exercise, infection and stress.  Hence, a thorough knowledge of the disease and how it alters normal body functions and the awareness of its acute and chronic complications is necessary. The present study thus tried to evaluate the comorbid conditions and concurrent medications associated with type 2 diabetic patients. It also aimed to address patient compliance for the medications provided to them. Materials and Methods: This was a cross-sectional observational study conducted for December 2023 to April 2024. Data were collected to determine the comorbidity and polypharmacy impact on patient with type 2 diabetes and also check the side effects, adverse drug reaction, other effects on patient, attending different local hospitals of Rawalpindi and Islamabad, Pakistan. Results: During the study period, 300 patients range from (15-80years). The majority were the females with (51%), and males were (49%). The mean of age and standard deviation taken from demographics 57.930 and 9.714, similarly mean and standard deviation of gender is 1.51 and 0.51 respectively. The age group less than 30 years is (2%) which is least effected. Age group 31-45 years (8%), 46-60 years is (44%), most effected age group is over 60 years with (46%). The present study evaluated that 86% of individuals with diabetes had at least one coexisting chronic condition. The findings of this study suggest that patients with diabetes who have multiple chronic conditions face a greater risk of polypharmacy the most common being Cardiovascular conditions (68%) and GIT diseases (54%). GI drugs were prescribed to 66% of the patients. The concurrent medications recommended included Alpha blockers (64%), NSAIDS (59%), Diuretics (35%), drugs for Antiepileptics (34%), and Antidepressants (8 %). Conclusion: The present study thus concluded that diabetic patients suffer from a number of comorbid conditions, most commonly, cardiovascular problems. The comorbidity increased with the age. The level of polypharmacy was also high, thereby increasing the pill burden for the patients.

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References

1. Agborsangaya, C. B., Lau, D., Lahtinen, M., Cooke, T., & Johnson, J. A. (2012). Health-related quality of life and healthcare utilization in multimorbidity: Results of a cross-sectional survey. Quality of Life Research, 22(4), 791-799.

https://doi.org/10.1007/s11136-012-0214-7

2. Alarcon, T. (1999). Factors predictive of outcome on admission to an acute geriatric ward. Age and Ageing, 28(5), 429-432.

https://doi.org/10.1093/ageing/28.5.429

3. Al-Nozha, M. M., Al-Maatouq, M. A., Al-Mazrou, Y. Y., & Al-Harthi, S. S. (2004). Diabetes mellitus in saudi arabia.

4. Austin, R. P. (2006). Polypharmacy as a risk factor in the treatment of type 2 diabetes. Diabetes Spectrum, 19(1), 13-16.

https://doi.org/10.2337/diaspect.19.1.13

5. Boccuzzi, S. J., Wogen, J., Fox, J., Sung, J. C., Shah, A. B., & Kim, J. (2001). Utilization of oral hypoglycemic agents in a drug-insured US population. Diabetes care, 24(8), 1411-1415.

https://doi.org/10.2337/diacare.24.8.1411

6. Buysschaert, M., & Bergman, M. (2011). Definition of prediabetes. Medical Clinics of North America, 95(2), 289-297.

https://doi.org/10.1016/j.mcna.2010.11.002

7. Canivell, S., & Gomis, R. (2014). Diagnosis and classification of autoimmune diabetes mellitus. Autoimmunity Reviews, 13(4-5), 403-407.

https://doi.org/10.1016/j.autrev.2014.01.020

8. Cohen, J. A., Jeffers, B. W., Faldut, D., Marcoux, M., & Schrier, R. W. (1998). Risks for sensorimotor peripheral neuropathy and autonomic neuropathy in non‐insulin‐dependent diabetes mellitus (NIDDM). Muscle & Nerve, 21(1), 72-80.

https://doi.org/10.1002/(sici)1097-4598(199801)21:1<72::aid-mus10>3.3.co;2-p

9. de Zeeuw, D., Remuzzi, G., Parving, H., Keane, W. F., Zhang, Z., Shahinfar, S., Snapinn, S., Cooper, M. E., Mitch, W. E., & Brenner, B. M. (2004). Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: Lessons from RENAAL. Kidney International, 65(6), 2309-2320.

https://doi.org/10.1111/j.1523-1755.2004.00653.x

10. Dinneen, S. F. (1997). The association of microalbuminuria and mortality in non—insulin-dependent diabetes mellitus. Archives of Internal Medicine, 157(13), 1413.

https://doi.org/10.1001/archinte.1997.00440340025002

11. Epstein, M., & Sowers, J. R. (1992). Diabetes mellitus and hypertension. Hypertension, 19(5), 403-418.

https://doi.org/10.1161/01.hyp.19.5.403

12. Filkova, M., Ibrahim, F., Norton, S., Scott, D., Mant, T., Cope, A., Molokhia, M., & Galloway, J. (2015). THU0079 Polypharmacy, although not combination Dmard therapy, in rheumatoid arthritis is associated with increased hospitalisation risk. Annals of the Rheumatic Diseases, 74, 220-221.

https://doi.org/10.1136/annrheumdis-2015-eular.3604

13. FRANKLIN, G. M., KAHN, L. B., BAXTER, J., MARSHALL, J. A., & HAMMAN, R. F. (1990). Sensory neuropathy in non-insulin-dependent diabetes mellitus. American Journal of Epidemiology, 131(4), 633-643.

https://doi.org/10.1093/oxfordjournals.aje.a115547

14. Galtier, F. (2010). Definition, epidemiology, risk factors. Diabetes & Metabolism, 36(6), 628-651.

https://doi.org/10.1016/j.diabet.2010.11.014

15. Gomes, E. R., & Demoly, P. (2005). Epidemiology of hypersensitivity drug reactions. Current Opinion in Allergy & Clinical Immunology, 5(4), 309-316.

https://doi.org/10.1097/01.all.0000173785.81024.33

16. Grant, R. W., Cagliero, E., Murphy-Sheehy, P., Singer, D. E., Nathan, D. M., & Meigs, J. B. (2002). Comparison of hyperglycemia, hypertension, and hypercholesterolemia management in patients with type 2 diabetes. The American Journal of Medicine, 112(8), 603-609.

https://doi.org/10.1016/s0002-9343(02)01103-8

17. Gregg, E. W., Gu, Q., Williams, D., De Rekeneire, N., Cheng, Y. J., Geiss, L., & Engelgau, M. (2007). Prevalence of lower extremity diseases associated with normal glucose levels, impaired fasting glucose, and diabetes among U.S. adults aged 40 or older. Diabetes Research and Clinical Practice, 77(3), 485-488.

https://doi.org/10.1016/j.diabres.2007.01.005

18. Gurwitz, J. H., Field, T. S., Harrold, L. R., Rothschild, J., Debellis, K., Seger, A. C., Cadoret, C., Fish, L. S., Garber, L., Kelleher, M., & Bates, D. W. (2003). Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA, 289(9), 1107.

https://doi.org/10.1001/jama.289.9.1107

19. Javanbakht, M., Abolhasani, F., Mashayekhi, A., & Baradaran, H. (2013). Health-related quality of life in patients with type 2 diabetes mellitus in Iran: A national survey. Primary Care Diabetes, 7(1), 72.

https://doi.org/10.1016/j.pcd.2012.10.046

20. Javanbakht, M., Abolhasani, F., Mashayekhi, A., Baradaran, H. R., & Jahangiri noudeh, Y. (2012). Health related quality of life in patients with type 2 diabetes mellitus in Iran: a national survey.

https://doi.org/10.1371/journal.pone.0044526

21. Kaufman, D. W., Kelly, J. P., Rosenberg, L., Anderson, T. E., & Mitchell, A. A. (2002). Recent patterns of medication use in the ambulatory adult population of the United States. JAMA, 287(3), 337.

https://doi.org/10.1001/jama.287.3.337

22. Lebovitz, H. E. (1999). Type 2 diabetes: An overview. Clinical Chemistry, 45(8), 1339-1345.

https://doi.org/10.1093/clinchem/45.8.1339

23. Malkani, S., & Mordes, J. P. (2011). Implications of using hemoglobin A1C for diagnosing diabetes mellitus. The American Journal of Medicine, 124(5), 395-401.

https://doi.org/10.1016/j.amjmed.2010.11.025

24. Mather, H., Chaturvedi, N., & Kehely, A. (1998). Comparison of prevalence and risk factors for microalbuminuria in south asians and Europeans with type 2 diabetes mellitus. Diabetic Medicine, 15(8), 672-677.

https://doi.org/10.1002/(sici)1096-9136(199808)15:8<672::aid-dia648>3.0.co;2-3

25. McDonald, T. J., & Warren, R. (2014). Diagnostic confusion? Repeat HbA1c for the diagnosis of diabetes. Diabetes Care, 37(6), e135-e136.

https://doi.org/10.2337/dc14-0055

26. Miettinen, H., Haffner, S. M., Lehto, S., Rönnemaa, T., Pyörälä, K., & Laakso, M. (1996). Proteinuria predicts stroke and other atherosclerotic vascular disease events in nondiabetic and non–insulin-dependent diabetic subjects. Stroke, 27(11), 2033-2039.

https://doi.org/10.1161/01.str.27.11.2033

27. Néss, S., Midthjell, K., Moum, T., Sørensen, T., & Tambs, K. (1995). Diabetes mellitus and psychological well-being. Results of the nord-trøndelag health survey. Scandinavian Journal of Social Medicine, 23(3), 179-188.

https://doi.org/10.1177/140349489502300308

28. Nguyen, J. K., Fouts, M. M., Kotabe, S. E., & Lo, E. (2006). Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. The American Journal of Geriatric Pharmacotherapy, 4(1), 36-41.

https://doi.org/10.1016/j.amjopharm.2006.03.002

29. O’Sullivan JB, Mahan CM. Criteria for the oral glucose tolerance test in pregnancy. Diabetes. 1964; 13:278–85.

30. Pablos-Méndez, A., Knirsch, C. A., Barr, R., Lerner, B. H., & Frieden, T. R. (1997). Nonadherence in tuberculosis treatment: Predictors and consequences in New York City. The American Journal of Medicine, 102(2), 164-170.

https://doi.org/10.1016/s0002-9343(96)00402-0

31. Peron, E. P., Ogbonna, K. C., & Donohoe, K. L. (2015). Antidiabetic medications and polypharmacy. Clinics in Geriatric Medicine, 31(1), 17-27.

https://doi.org/10.1016/j.cger.2014.08.017

32. Roglic, G., & Colagiuri, S. (2014). Gestational diabetes mellitus: Squaring the circle. Diabetes Care, 37(6), e143-e144.

https://doi.org/10.2337/dc14-0344

33. Rollason, V., & Vogt, N. (2003). Reduction of polypharmacy in the elderly. Drugs & Aging, 20(11), 817-832.

https://doi.org/10.2165/00002512-200320110-00003

34. Sacks, D. B., Arnold, M., Bakris, G. L., Bruns, D. E., Horvath, A. R., Lernmark, Å., Metzger, B. E., Nathan, D. M., & Kirkman, M. S. (2023). Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus.

https://doi.org/10.2337/figshare.23519148.v1

35. Shaw, J. E., D'Emden, M. C., & Goodall, I. (2011). Is Australia ready to use glycated haemoglobin for the diagnosis of diabetes? Medical Journal of Australia, 195(1), 7-8.

https://doi.org/10.5694/j.1326-5377.2011.tb03178.x

36. Stocks, S. J., Kontopantelis, E., Akbarov, A., Rodgers, S., Avery, A. J., & Ashcroft, D. M. (2015). Examining variations in prescribing safety in UK general practice: Cross sectional study using the clinical practice research Datalink. BMJ, h5501.

https://doi.org/10.1136/bmj.h5501

37. Stone, M. A., Camosso‐Stefinovic, J., Wilkinson, J., De Lusignan, S., Hattersley, A. T., & Khunti, K. (2010). Incorrect and incomplete coding and classification of diabetes: A systematic review. Diabetic Medicine, 27(5), 491-497.

https://doi.org/10.1111/j.1464-5491.2009.02920.x

38. Tiihonen, J. (2012). Polypharmacy with antipsychotics, antidepressants, or benzodiazepines and mortality in schizophrenia. Archives of General Psychiatry, 69(5), 476.

https://doi.org/10.1001/archgenpsychiatry.2011.1532

39. Toobert, D. J., Hampson, S. E., & Glasgow, R. E. (2000). The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale. Diabetes Care, 23(7), 943-950.

https://doi.org/10.2337/diacare.23.7.943

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Published

2026-03-30

How to Cite

Raza, M. H., Shahnaz, S., Riaz, S., Zain Ul Abideen, M., Khan Luqmani , A. I., Hayat, M. A., Murtaza, M. A., & Mansoor, S. (2026). Polypharmacy and Comorbidity Status in the Treatment of Type 2 Diabetic Patients Attending Tertiary Care Hospitals. Indus Journal of Bioscience Research, 4(3), 37-42. https://doi.org/10.70749/ijbr.v4i3.2980