Polypharmacy in the Spanish Population with Diabetes: Sociodemographic, Clinical, and Lifestyle Determinants Based on the 2020 and 2023 National Health Surveys

Background/Objectives. Polypharmacy is increasingly common among people with diabetes, who frequently accumulate comorbidities and guideline-driven drug therapies. This study aimed to estimate the prevalence of polypharmacy among Spanish adults with diabetes and to identify its sociodemographic, clinical, and lifestyle determinants, comparing data from 2020 and 2023. Methods. A cross-sectional study was done. The year 2020 European Health Interview Survey in Spain and the year 2023 Spanish National Health Survey were the databases used. We applied a 1:1 matching by age, sex, and autonomous community of residence. Adults with physician-diagnosed diabetes were compared with matched controls without diabetes. Polypharmacy was defined as the concurrent use of 5 or more of 10 selected non-antidiabetic drug classes. Sex-specific univariable and multivariable logistic regression models were fitted. Results. The prevalence of polypharmacy among participants with diabetes increased from 18.5% in 2020 to 22.1% in 2023 versus 7.7% and 11.2% among matched controls. In 2023, polypharmacy was more frequent among participants with diabetes than among their matched controls in both sexes, affecting 29.3% of women (vs. 16.1% of controls) and 14.8% of men (vs. 6.2% of controls). Poor self-perceived health (OR 4.84, 95% CI 2.94–7.99, in men; OR 4.13, 95% CI 2.82–6.06, in women), chronic mental health problems (OR 4.36, 95% CI 3.01–6.31, in men; OR 4.19, 95% CI 3.22–5.44, in women), hypertension (OR 2.74, 95% CI 1.81–4.15 in men; OR 3.52, 95% CI 2.58–4.80, in women), and, among women, older age (OR 1.03, 95% CI 1.01–1.04, per year) and alcohol consumption (OR 1.60, 95% CI 1.16–2.22) were independent determinants of polypharmacy in the group with diabetes. Conclusions. Polypharmacy is highly prevalent among Spanish adults with diabetes—particularly older women with multimorbidity—and rose between 2020 and 2023 in parallel with population-wide trends. Integrated chronic care models and systematic deprescribing strategies, rather than single-disease prescribing approaches, are needed.