Polypharmacy and Glycemic Status in Individuals with Diabetes and Pre-diabetes: Iranian Multi-Center Osteoporosis Study 2021

Objectives: This study examined the association between polypharmacy and glycemic status among adults aged ≥ 50 years. Materials and Methods: This cross-sectional analysis included 1,117 participants from the 2021 Iranian Multi-center Osteoporosis Study (XXX). Data on sociodemographic characteristics, lifestyle factors, clinical and biochemical measures, and medication use were collected using standardized questionnaires, physical examinations, laboratory assessments, and direct observation of medication packages. Polypharmacy was assessed using thresholds of ≥ 3 and ≥ 5 concurrent medications. Weighted prevalence estimates with 95% confidence intervals (CIs) were calculated, and multivariable logistic regression models were used to examine the association between polypharmacy and glycemic status, with adjustment for relevant demographic and health-related factors. Results: Polypharmacy was more common in individuals with diabetes than in those with pre-diabetes (≥ 3 medications: 49.89% vs. 28.25%; ≥ 5 medications: 26.28% vs. 9.82%).The mean number of medications was also higher among individuals with diabetes than among those with pre-diabetes (2.94 vs. 1.58). Among individuals receiving antidiabetic medications, polypharmacy defined as ≥ 5 medications was associated with higher odds of uncontrolled diabetes [adjusted odds ratio (AOR) = 2.21; 95% CI: 1.49, 3.29]. Each additional medication was also associated with higher odds of uncontrolled diabetes (AOR = 1.20; 95% CI: 1.12, 1.28). Conclusion: Polypharmacy was associated with poorer glycemic control among adults aged ≥ 50 years. The association between polypharmacy and uncontrolled diabetes was particularly evident among those using ≥ 5 medications. These findings highlight the importance of considering overall medication burden when managing diabetes in this population.