Polypharmacy in diabetes: A nation-wide, pharmacy-based, observational study

Abstract

Aim: The aim of the present study was to build a classification of diabetes according to the time-sequence of treatment. A second aim was to describe the diversity of drugs prescribed for diabetes and associated conditions in a nation-wide cohort of patients with diabetes. Patients and method: LRx is an outpatient care nation-wide medication dispense database. It consists of a panel of 10,000 retail pharmacies in France. We developed an algorithm to find out the number of patients treated for diabetes from July 2018 to June 2019 and to classify diabetes types and the sequence of drugs dispense over the years, including treatments for the control of diabetes itself and drugs for associated conditions. Results: A raw number of 2.3 million patients was studied, corresponding to an extrapolated 3.9 million patients in mainland France. Seven percent were classified as having Type 1 Diabetes, 86% Type 2 Diabetes (T2D), 0.5% insulin-treated gestational diabetes, and 6% remained unclassified. In subjects with T2D, metformin was the most frequently prescribed glucose lowering drug, followed by DPP4 inhibitors and sulfonylureas. Main coprescribed medication classes were lipid-modifying agents and antihypertensive agents. Of note, about a third of the patients received neuropsychiatric drugs and 40% a proton-pump inhibitor. We also had an unbiased view of compliance to treatment, that was below 50%. Conclusion: The algorithm we built could be used to monitor changes of strategies to control blood glucose and comorbidities. Our findings highlight the burden of polypharmacy in patients with diabetes.

Keywords

• Diabetes
• Epidemiology
• Polytherapy