4.3 Implication for policy and practice
Polypharmacy can be considered as an indicator for medication burden,
although it does not indicate inappropriate medication. In older people
with diabetes, we observed a small decrease in patients with any PIM
among an increasing population with polypharmacy. Despite this trend,
more than a quarter of older people with diabetes and polypharmacy
received at least one PIM. Notably, in the middle-aged group the
prevalence of PIM appears to be higher and did not decrease. One should
be aware, however, that comparing the absolute prevalence rates between
the groups is restricted by the use of different PIM lists for different
age groups. Importantly, at individual PIM level many PIMs were not
decreasing in older nor middle-aged people with diabetes.
It is therefore important not only to focus on older patients with PIM.
To decrease inappropriate polypharmacy, attention should be paid to
specific PIMs and to specific high-risk populations, such as those with
diabetes. Multifaceted, patient-centered interventions have shown to be
effective at reducing inappropriate medication in the general older
population [34,35]. Developing such interventions for middle-aged
people with diabetes may be necessary. More research is needed to assess
the benefits versus harms caused by PIMs in middle-aged populations.