Polypharmacy for Older Adults With Diabetes Reaches as High As 95.3%

A comprehensive systematic review and meta-analysis published in the journal Pharmacy reveals that older adults living with type 2 diabetes (T2D) face a staggering burden of medication use, with the prevalence of polypharmacy reaching as high as 95.3% in some cohorts. The study, which synthesized data from over 13,350 participants 65 years and older, underscores the high co-occurrence of potentially inappropriate medications (PIMs) among those already managing complex multidrug regimens.¹

With PIM prevalence recorded as high as 74% in certain populations, the research highlights a pressing need for pharmacists to look beyond simple medication counts and prioritize structured, clinically contextualized medication reviews.

“Across the included studies, polypharmacy prevalence ranged from 43.6% to 95.3%, while PIM prevalence ranged from 23.4% to 74%, highlighting a significant medication burden among older adults with T2DM. Heterogeneity was extremely high for both polypharmacy (I² = 98.6%, 95% CI 98–99.1%) and PIM use (I² = 97.6%, 95% CI 96.2–98.5%),” the study authors said.¹

The conventional definition of polypharmacy—the concurrent use of 5 or more medications—is a frequent reality for older diabetic patients who often contend with a cluster of cardiometabolic comorbidities such as hypertension, dyslipidemia, and chronic kidney disease. However, contemporary medical guidance suggests that a purely numerical threshold may be insufficient for this specific population.^1,2

“Clinically, these findings are plausible and help explain the high prevalence of polypharmacy and PIM observed in this review, reflecting the complexity of T2DM management. Older adults with T2DM often require multidrug regimens for glycemic control and comorbidity management, as well as for guideline-recommended management of cardio-renal and vascular risk factors,” the study authors said.¹

Experts now differentiate between inappropriate polypharmacy, where the risk of harm outweighs clinical benefits, and appropriate polypharmacy, where multiple evidence-based therapies are necessary to achieve multifaceted health goals and reduce the risk of long-term complications. In the context of T2DM, the absence of polypharmacy might even indicate under-prescribing or missed opportunities for essential cardiovascular risk reduction.^2,3

Despite the potential necessity of multiple therapies, the Pharmacy meta-analysis found that the burden of inappropriate prescribing remains significant, with common PIM classes including long-acting sulfonylureas, proton pump inhibitors, and benzodiazepines. Long-acting sulfonylureas are particularly concerning for older adults due to an increased susceptibility to severe hypoglycemia, which has been linked to adverse outcomes like falls, fractures, and even cardiac events such as QTc prolongation.¹

Pharmacists play a vital role in identifying these risks, especially as age-related physiological changes—including reduced renal and hepatic clearance and altered drug sensitivity—heighten the danger of adverse drug reactions.^2,3

The risk of a prescribing cascade further complicates the management of older diabetic patients. This occurs when an adverse effect of one medication is misinterpreted as a new medical condition, leading to the prescription of additional drugs and further escalating regimen complexity. For example, symptoms like confusion, falls, or lethargy caused by drug interactions might be mistaken for signs of normal aging.^1,2

Pharmacists are uniquely positioned to intercept these cascades by conducting meticulous medication reconciliations and using explicit screening tools like the American Geriatrics Society Beers Criteria or the STOPP/START criteria to identify drugs that no longer align with a patient's goals of care.²

Optimizing therapy in this population requires a shift toward patient-centered decision-making and, when appropriate, the proactive practice of deprescribing. Although numerical polypharmacy may be a permanent fixture of modern diabetes care, the goal for health care teams is to ensure that every medication in a patient’s regimen is optimized for safety and efficacy.^1-3

By focusing on clinical appropriateness rather than just the number of pills in a bottle, pharmacists can help reduce the stigma of taking too many medications while simultaneously protecting older adults from the preventable harms of inappropriate polypharmacy.^1-3

REFERENCES

1. Aljaizani RA, Althumairi AA, Alamer KA, Ahmad S. Prevalence and Association of Polypharmacy and Potentially Inappropriate Medications Among Older Adults with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Pharmacy (Basel). 2026;14(3):65. Published 2026 Apr 28. doi:10.3390/pharmacy14030065

2. Johns Hopkins Medicine. Polypharmacy in Adults 60 and Older. March 11, 2024. Accessed May 28, 2026. https://www.hopkinsmedicine.org/health/wellness-and-prevention/polypharmacy-in-adults-60-and-older

3. Varghese D, Patel P. Polypharmacy. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532953/

4. Saeed ZI, Ostrominski JW, Aroda VR. Polypharmacy in Type 2 Diabetes: Appropriate or Cause for Concern?. Diabetes Care. 2024;47(12):2104-2106. doi:10.2337/dci24-0035