Managing Multiple Medications With Diabetes

Managing Multiple Medications With Diabetes

Diabetes is a complex chronic condition that requires multidisciplinary care.1,2 Along with the management of hyperglycemia and prevention of microvascular (eg, diabetic retinopathy, neuropathy) and macrovascular complications (eg, coronary artery disease, stroke),1 people with diabetes often need management of comorbidities that coexist with diabetes.3 Chronic health conditions such as hypertension (ie, high blood pressure), chronic kidney disease, dyslipidemia (ie, unbalance of blood lipid levels), coronary artery disease, depression, among others, are common among people with diabetes.

Managing diabetes along with its potential complications and coexisting comorbidities can require multiple medications.4,5 Although definitions vary, polypharmacy most commonly refers to taking more than 5 medications every day.6 It is thought that 50-60% of people with diabetes take at least 4-6 medications daily.4 Among older adults with diabetes, polypharmacy has been reported to up to over 80% in certain studies.3 

Are There Risks to Taking Too Many Medications?

Although prescription of various medications begin for good reasons, polypharmacy carries with it various risks.3,7 Research has consistently shown that certain unwanted outcomes may be more common among people who take multiple medications:

  • More likely to experience side effects from medication(s)
  • More drug-to-drug interactions
  • More expensive
  • Less likely for patients to take medications as instructed
  • More likely to be errors in prescriptions
  • Risk of being prescribed similar medication(s) more than once
  • More likely to be prescribed with more drugs to treat side effect(s) mistaken as new medical condition(s)
  • Risk of unwanted geriatric syndromes: falls and fractures, confusion, urinary issues, constipation, insomnia, orthostatic hypotension (ie, sudden decreases in blood pressure with positional change)


How Can I Manage Taking Multiple Medications?

Sometimes taking multiple medications is necessary to manage various medications, and it is possible to prevent or minimize various risks and errors associated with polypharmacy by following a few simple tips.7

  1. Tell your doctor or pharmacist about all the medications you are taking

As most patients see many health care providers, it is important to inform each doctor or pharmacist you see about all the medications you are taking. This includes medications prescribed by other doctors as well as all non-prescribed over the counter (OTC) medications (eg, vitamin supplements, pain medications, allergy medications, sleep medications, etc.). This is necessary so that health care providers can avoid prescribing duplicate medications and help avoid potential drug-to-drug interactions with prescribed or OTC medications.

  1. Have a list of all the medications you take and use a pill box

To help keep track of all the medications, having a comprehensive list of all prescribed and OTC medications can be very helpful. If this is too difficult or not possible, you can also bring in all your medications whenever you see your health care providers.

  1. Be informed and take note of any new changes or side effects you experience

Being aware of the potential side effects of medications prior and keeping note of them while taking the medications can be helpful in both the short and the long term. Certain side effects are mild, temporary, or easily managed and being aware of them can allow you to properly take the necessary medications without being deterred by the side effects. However, certain side effects can be serious and warrant informing health care providers so that medications can be switched or deprescribed.

  1. Talk to your doctor or pharmacist about a medication if you are not sure what or why you were prescribed

It is known that patients are less likely to take or properly take medications patients do not know they were prescribed, why they were prescribed, and how they should be taken. It is important to ask your doctors or pharmacists about your medications if there are any confusions or questions.

  1. Ask your doctor if there are any unnecessary medications that can be deprescribed

As more medications are added to your list, it is important for both you and your health care providers to continuously review them. If there are any duplicate medications, medications you are not sure why you are taking, or if you are experiencing serious side effects, ask your doctor about them and whether they can be deprescribed if they are not necessary.



1. Peron EP, Ogbonna KC, Donohoe KL. Diabetic Medications and Polypharmacy. Clin Geriatr Med. 2015;31(1):17-vii. doi:10.1016/j.cger.2014.08.017
2. AL-Musawe L, Martins AP, Raposo JF, Torre C. The Association Between Polypharmacy and Adverse Health Consequences in Elderly Type 2 Diabetes Mellitus Patients; a Systematic Review and Meta-Analysis. Diabetes Res Clin Pract. 2019;155:107804. doi:10.1016/j.diabres.2019.107804
3. Alwhaibi M, Balkhi B, Alhawassi TM, et al. Polypharmacy Among Patients with Diabetes: A Cross-Sectional Retrospective Study in a Tertiary Hospital in Saudi Arabia. BMJ Open. 2018;8(5):e020852. doi:10.1136/bmjopen-2017-020852
4. Remelli F, Ceresini MG, Trevisan C, Noale M, Volpato S. Prevalence and Impact of Polypharmacy in Older Patients with Type 2 Diabetes. Aging Clin Exp Res. 2022;34(9):1969-1983. doi:10.1007/s40520-022-02165-1
5. Dobrică EC, Găman MA, Cozma MA, Bratu OG, Pantea Stoian A, Diaconu CC. Polypharmacy in Type 2 Diabetes Mellitus: Insights from an Internal Medicine Department. Medicina (Kaunas). 2019;55(8):436. doi:10.3390/medicina55080436
6. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What Is Polypharmacy? A Systematic Review of Definitions. BMC Geriatr. 2017;17:230. doi:10.1186/s12877-017-0621-2
7. Good CB. Polypharmacy in Elderly Patients With Diabetes. Diabetes Spectrum. 2002;15(4):240-248. doi:10.2337/diaspect.15.4.240



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