The Prevalence and Implications of Polypharmacy in Individuals With Type 1 Diabetes

Polypharmacy is increasingly recognized as a relevant issue in diabetes care, but its prevalence and clinical relevance in individuals with type 1 diabetes remain underexplored. This study aimed to determine the prevalence of polypharmacy and to identify associated clinical and psychological factors. Participants were recruited from a tertiary diabetes outpatient clinic between February 2020 and April 2021. Polypharmacy was defined as the concurrent use of five or more medications, including insulin. Clinical, sensor-based, and psychosocial data were collected. Logistic regression was used to identify variables independently associated with polypharmacy. A total of 484 individuals with type 1 diabetes were included (mean age 51.3 ± 15.9 years; 51.2% male; median diabetes duration 30 [IQR 16-40] years; mean HbA_1c 60.3 ± 11.6 mmol/mol). Polypharmacy was present in 175 (36.2%) participants. Individuals with polypharmacy were more often female, were older, and had longer diabetes duration, higher BMI, higher HbA_1c, more complications, and higher rates of hospital admission. They also were more likely to have impaired awareness of hypoglycemia and reported higher levels of fear of hypoglycemia with no differences in hyperglycemia-related worry or behavior or diabetes-related emotional distress. Polypharmacy affects over one-third of individuals with type 1 diabetes and is associated with poorer health status and a greater hypoglycemia-related burden. Future studies should investigate whether targeted medication review and psychological interventions may alleviate some of the burden in this high-risk group.