due to the side effects of disease managing medications. The need to take medication to manage a diabetic condition often requires a lifestyle adjustment, and the recognition of the importance of disease management is cause for attention to self-care. With the disease under control while concurrently addressing other chronic illness and adverse effects, diabetics may struggle to adapt strategies for the issues presented by polypharmacy. Healthcare providers will need to collaborate with these patients to ensure that regular medication reviews are conducted, that glycemic targets are adjusted as appropriate, and that supervised deprescribing occurs should there be signs of dangerous changes and responses (Table 8).
with glycemic control, presentation of hypoglycemic events, syncope, which can exacerbate diabetes complications and impair quality of life. Additionally, older diabetic patients with polypharmacy who experience autonomic neuropathy appear to have increased risk of falls. It is not known if this is from the challenges of neuropathy, a hypoglycemic event, or the combination of medications such as antihypertensive, alpha-blockers, and benzodiazepines that are correlated to increased fall risk. These potential outcomes can change a diabetic’s sense of independence and can lead to increased risk of hospitalization, expanded multimorbidity, and even death. For diabetics struggling with the effects of polypharmacy, there is an often-expressed negative impact on quality of life
Table 8: Diabetes Polypharmacy Diabetes and Other Chronic Condition Medications
Attributes
Potential Polypharmacy
Insulin
Rapid acting, short acting, intermediate acting, and long-acting
Sulfonylureas Metformin Pioglitazone
Oral hypoglycemic agents
Hypoglycemia, weight gain
First-line therapy
Monitor for fluid retention and heart failure
Enhances insulin therapy
Monitor for fluid retention and heart failure
DPP-4 inhibitors (sitagliptin, saxagliptin) GLP-1 receptor agonists
Increase incretin hormone levels, promotes insulin release
Expensive
Delays gastric dumping
SGLT-2 inhibitors ACE inhibitors
Promote glucose excretion in urine
Monitor for genital infections and dehydration
Protects kidneys and reduce cardiovascular risk
Calcium channel blockers
Manage hypertension and prevent complications
Lipid-Lowering Agents (Statins)
Reduce LDL cholesterol
Muscle pain and can impact liver function
Fibrates
Lower triglycerides and increases HDL cholesterol
Can impair kidneys
Aspirin NSAIDs
Prevents heart issues or events
Increase bleeding risks
Chronic pain and arthritis
Can cause renal and GI issues
Proton pump inhibitors
Manages GERD symptoms
Can interact with other drugs
(Lu et al., 2023)
Case study 2: Bob Stevens—Patient with diabetes Background Bob Stevens is a retired schoolteacher who has been managing type 2 diabetes for over a decade. His health journey is marked by the ongoing and delicate balance between glycemic control, cardiovascular health, and quality of life. Patient Profile ● Name : Bob Stevens ● Age : 76 years Medical conditions ● Type 2 diabetes : Diagnosed at age 65 ● Dyslipidemia : Controlled with simvastatin (Zocor) ● Hypertension : Managed for 8 years ● Chronic degenerative joint disease : Affects knees and back
● Gastroesophageal reflux disease (GERD) : Occasional symptoms ● Angina pectoris : Post-myocardial infarction ● Prostatic hypertrophy : Lower urinary tract symptoms Medication regimen 1. Glyburide (Micronase): For glycemic control 2. Metformin (Glucophage): Adjunct therapy for diabetes 3. Simvastatin (Zocor): Maintains LDL cholesterol (89 mg/dl) 4. Aspirin : Post-MI prophylaxis 5. Naproxen and Advil PM : Duplicate NSAIDs (requires adjustment) 6. Angiotensin-converting enzyme (ACE) inhibitor : For hypertension 7. Beta-blocker : Post-MI management 8. Pain management : Addressing neuropathy and joint pain
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Book Code: MTX1326
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