The association of polypharmacy and high-risk drug classes with adverse health outcomes in the Scottish population with type 1 diabetes.
Accidental Falls
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Databases, Factual
Diabetes Mellitus, Type 1
/ drug therapy
Female
Humans
Hypoglycemic Agents
/ therapeutic use
Infant
Infant, Newborn
Insulin
/ therapeutic use
Male
Middle Aged
Polypharmacy
Scotland
/ epidemiology
Young Adult
Acute complications of diabetes
Ageing
DKA
High-risk prescribing
Hypoglycaemia
Medication reviews
Mortality
Multimorbidity
Polypharmacy
Type 1 diabetes
Journal
Diabetologia
ISSN: 1432-0428
Titre abrégé: Diabetologia
Pays: Germany
ID NLM: 0006777
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
19
08
2020
accepted:
03
12
2020
pubmed:
21
2
2021
medline:
23
2
2022
entrez:
20
2
2021
Statut:
ppublish
Résumé
The aim of this work was to map the number of prescribed drugs over age, sex and area-based socioeconomic deprivation, and to examine the association between the number of drugs and particular high-risk drug classes with adverse health outcomes among a national cohort of individuals with type 1 diabetes. Utilising linked healthcare records from the population-based diabetes register of Scotland, we identified 28,245 individuals with a diagnosis of type 1 diabetes on 1 January 2017. For this population, we obtained information on health status, predominantly reflecting diabetes-related complications, and information on the total number of drugs and particular high-risk drug classes prescribed. We then studied the association of these baseline-level features with hospital admissions for falls, diabetic ketoacidosis (DKA), and hypoglycaemia or death within the subsequent year using multivariate Cox proportional hazards models. Not considering insulin and treatment for hypoglycaemia, the mean number of prescribed drugs was 4.00 (SD 4.35). The proportion of individuals being prescribed five or more drugs at baseline consistently increased with age (proportion [95% CI]: 0-19 years 2.04% [1.60, 2.49]; 40-49 years 28.50% [27.08, 29.93]; 80+ years 76.04% [67.73, 84.84]). Controlling for age, sex, area-based socioeconomic deprivation and health status, each additional drug at baseline was associated with an increase in the hazard for hospitalisation for falls, hypoglycaemia and death but not for DKA admissions (HR [95% CI]: falls 1.03 [1.01, 1.06]; DKA 1.01 [1.00, 1.03]; hypoglycaemia 1.05 [1.02, 1.07]; death 1.04 [1.02, 1.06]). We found a number of drug classes to be associated with an increased hazard of one or more of these adverse health outcomes, including antithrombotic/anticoagulant agents, corticosteroids, opioids, antiepileptics, antipsychotics, hypnotics and sedatives, and antidepressants. Polypharmacy is common among the Scottish population with type 1 diabetes and is strongly patterned by sociodemographic factors. The number of prescribed drugs and the prescription of particular high-risk drug classes are strong markers of an increased risk of adverse health outcomes, including acute complications of diabetes.
Identifiants
pubmed: 33608768
doi: 10.1007/s00125-021-05394-7
pii: 10.1007/s00125-021-05394-7
pmc: PMC8099818
doi:
Substances chimiques
Hypoglycemic Agents
0
Insulin
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1309-1319Références
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