3819 Polypharmacy and potentially inappropriate prescribing in type 2 diabetes: a nationally comprehensive analysis of Scottish data

Abstract Introduction This study assessed national trends in polypharmacy and potentially inappropriate prescribing among people with type 2 diabetes in Scotland, 2012 to 2022. Methods We analysed nationwide data from the Scottish Care Information–Diabetes database. Individuals aged ≥40 years with type 2 diabetes between 2012 and 2022 were included. Medication counts were based on unique medications dispensed per year excluding those for short-term indications (e.g. antibiotics). Potentially inappropriate medications were based on 2023 Beers criteria applied to people over 65 years. A Poisson mixed-effects model with individual-level random intercepts assessed the relationship between polypharmacy and gender, age group, and socioeconomic status, Elixhauser comorbidity index and the hospital frailty risk score. Results 387,338 people with type 2 diabetes were included. Median number of medications dispensed was 9 (IQR 5–13). People over 65 were dispensed a median of 2 (IQR 1–3) potentially inappropriate medications. Adjusted medication counts were modestly higher in older people (rate ratio RR 1.06, 95% confidence interval CI 1.06–1.06 at age 80+ compared to 40–59), females (1.14, 1.13–1.14), in more deprived areas (1.24, 1.23–1.24 in most deprived vs most affluent quintile) and with higher comorbidity (1.12, 1.12–1.13 in 4+ vs 0 comorbidities) but not with high frailty risk (1.00, 1.00–1.00). Potentially inappropriate medication showed a similar pattern except a stronger association with comorbidity (1.24, 1.23–1.25) and a positive association with high frailty risk (1.24, 1.23–1.25). Rates of polypharmacy and potentially inappropriate prescribing showed minimal changes across calendar time. Conclusions Polypharmacy is the norm among people with type 2 diabetes, and most people aged over 65 are prescribed two or more potentially risky medications each year. Understanding how this impacts diabetes management, risk of adverse outcomes, and quality of life is a priority in order to optimise care for people with type 2 diabetes.