Trends in polypharmacy and potentially inappropriate medication (PIM) in older and middle-aged people treated for diabetes

Monika Pury Oktora*, Sofa Dewi Alfian, H Jens Bos, Catharina Carolina Maria Schuiling-Veninga, Katja Taxis, Eelko Hak, Petra Denig

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Aims Polypharmacy is common in people with diabetes and is associated with the use of potentially inappropriate medication (PIM). This study aimed to assess trends in the prevalence of polypharmacy and PIM in older and middle-aged people with diabetes.

Methods A repeated cross-sectional study using the University Groningen prescription database was conducted. All people aged 45 years and over who were treated for diabetes registered in the period 2012-2016 were included. Polypharmacy was assessed for three age groups. PIMs were assessed using Beers criteria for people >= 65 years old, and PRescribing Optimally in Middle-aged People's Treatments (PROMPT) criteria for 45-64 years old. Chi-square tests and regression analysis were applied.

Results The prevalence of polypharmacy increased significantly in all age groups in the study period. In 2016, the prevalence of polypharmacy was 36.9% in patients aged 45-54 years, 50.3% in those aged 55-64 years, and 66.2% in those aged >= 65 years. The prevalence of older people with at least one PIM decreased by 3.1%, while in the middle-aged group this prevalence increased by 0.9% from 2012 to 2016. The most common PIMs in both age groups were the use of long-term high-dose proton pump inhibitors, benzodiazepines and strong opioids without laxatives. Of those, only benzodiazepines showed a decreasing trend.

Conclusions Polypharmacy increased in older and middle-aged people with diabetes. While the prevalence of PIM decreased over time in older age, this trend was not observed in middle-aged people with diabetes. Efforts are needed to decrease the use of PIMs in populations already burdened with many drugs, notably at middle age.

Original languageEnglish
Pages (from-to)2807-2817
Number of pages11
JournalBritish Journal of Clinical Pharmacology
Issue number7
Early online date2-Dec-2020
Publication statusPublished - Jul-2021


  • diabetes
  • polypharmacy
  • potentially inappropriate medication (PIM)
  • prevalence

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