See the section on polypharmacy in diabetes for further information.

This NTI highlights individuals prescribed three or more categories of anti-diabetic drugs. These patients may also be prescribed additional medication for other co-morbidities, further increasing the risks associated with polypharmacy.

Polypharmacy in diabetes

• Polypharmacy can be appropriate, ensuring that people with diabetes achieve target HbA1c levels.
• Polypharmacy can also be inappropriate either:
  • due to over treatment, e.g., increasing risks of hypoglycaemia and falls
  • ineffective polypharmacy resulting in increased risks of adverse effects, but no benefit in treatment outcomes.
• The various categories of anti-diabetic medication have differing effects on glycaemic control and therefore those less effective in achieving the target HbA1c should be reviewed.
• Polypharmacy increases the risk of Adverse Drug Reactions.
• The 7 Steps medication review process should be used during medicine reviews.
• Prescribers should work with patients to develop an understanding of the importance of self-management and the successful achievement of goals. This will include aspects such as medication sick day guidance and lifestyle changes.