Therapeutic-Category Medication Burden Among Adults With Treated Diabetes in the Health Survey for England 2022

Abstract Background Polypharmacy is commonly defined using counts of individual medicines, but definitions vary and category-based measures capture a different construct. We described therapeutic-category medication burden and associated sociodemographic patterns among adults with treated diabetes in the Health Survey for England (HSE) 2022 nurse-visit analytical sample. Methods Cross-sectional HSE 2022 data included adults (≥ 16 years) who completed the nurse visit, reported diabetes, and received antidiabetic treatment ( N = 262). Medication burden was the number of six broad therapeutic categories with ≥ 1 prescribed medicine taken in the past 7 days; the primary outcome was ≥ 3 categories. Analyses were unweighted and describe the selected analytical sample rather than population-level prevalence. Logistic regression examined age, sex and area deprivation; treatment-modality analyses included 256 participants with classifiable treatment status. Sensitivity analyses examined stricter thresholds of ≥ 4 and ≥ 5 categories and alternative outcome definitions excluding antibacterial medications and excluding both antibacterial medications and NSAIDs. Results Overall, 107/262 participants (40.8%; exact 95% CI 34.8–47.1) met the ≥ 3-category threshold. The 55–64-year group had higher adjusted odds than the < 55 group (aOR 3.07, 95% CI 1.12–8.46), and the most deprived quintile had higher odds than the least deprived quintile (aOR 3.21, 95% CI 1.38–7.47); however, overall Wald tests for age ( p = 0.128) and deprivation ( p = 0.089) were not statistically significant. No statistically significant differences were detected across treatment groups (overall Wald p = 0.824), and estimates were imprecise, particularly for insulin-only users. Using stricter thresholds, 11.1% (29/262; 95% CI 7.5–15.5) met the ≥ 4-category threshold and 3.4% (9/262; 95% CI 1.6–6.4) met the ≥ 5-category threshold. Excluding antibacterial medications had little effect on the ≥ 3-category proportion (40.5%), whereas excluding both antibacterial medications and NSAIDs reduced it to 35.9%. Conclusions In this HSE nurse-visit analytical sample, about two in five participants met the study-specific ≥ 3-category medication-burden threshold. Higher burden was observed in some age and deprivation groups, while no clear differences were detected across diabetes treatment modalities. The findings highlight the breadth of therapeutic-category exposure among adults with treated diabetes and the potential value of comprehensive medication review that considers both clinical and socioeconomic context.