Polypharmacy in older patients with diabetes mellitus: a population based-study of northern Italy

Aims: To evaluate the trends in chronic polypharmacy and identify predictors of polypharmacy exposure in a population residing in Lombardy region of Italy. Methods: Using an administrative health database, we identified individuals aged 65–90 years with diabetes mellitus (DM) treated with antihyperglycemic drugs from 2010 to 2022. The trend of chronic polypharmacy was assessed using the Cochran-Armitage trend test. An adjusted logistic regression model was employed to analyze predictors of polypharmacy exposure. Results: The number of older patients with DM increased from 243,160 in 2010 to 314,238 in 2022. The prevalence of polypharmacy exposure rose from 13.8% in 2010 to 15.8% in 2013, followed by a decline starting in 2014. Notably, in 2020, the prevalence dropped to 11.8%, further decreasing to 9.1% in 2021, before rising again to 11.7% in 2022. We also observed an increased use of recommended antihyperglycemic drugs over time. Significant predictors of polypharmacy exposure included advanced age, female sex, comorbidities, and use of DPP-4i, GLP-1-RA, insulin, and SGLT2-i. Conclusions: The observed decrease in polypharmacy in the latter years of the study period may reflect improvements in the management of older patients with DM, aligning with recommended therapies, particularly for those at higher risk of polypharmacy.