Diabet hastalarında polifarmasi ve ilaç ilaç etkileşimleri

Öz

Amaç: Diabetes Mellitus kronik bir hastalıktır. Çalışmamızın amacı diyabetik hastalarda ilaç-ilaç etkileşimlerini ve polifarmasiyi değerlendirmektir. Yöntemler: Nisan 2019 ile Temmuz 2019 tarihleri arasında dahiliye ve endokrinoloji polikliniğimize başvuran tip 2 diyabetli hastalar çalışmaya dahil edildi. Prospektif, tanımlayıcı ve kesitsel bir çalışma olarak tasarlandı. Diyabetli bireylerin sosyo-demografik özellikleri, diyabet tedavisinde kullandıkları ilaçlar ve eşlik eden diğer hastalıkları ATC sınıflamasına göre değerlendirildi. Bu çalışmada çoklu ilaç ve polifarmasi arasındaki etkileşimler incelenmiştir. Sonuçlar Araştırmanın evrenini yaşları 18-87/yıl (59±11) arasında değişen 526 hasta oluşturdu. Hastaların %69,6'sı kadındı. Hastaların %83,8'inde diyabete eşlik eden kronik hastalıklar vardı. En sık görülen kronik hastalıklar sırasıyla hipertansiyon (%53,6), hiperlipidemi (%41,4) ve koroner arter hastalığı (%27,2) olarak belirlendi. Hastaların %45,01'i beş ve daha fazla ilaç kullanıyordu. Ortalama ilaç sayısı ise 4,49±1,93 olarak belirlendi. Hastaların kullandığı ilaçlardan toplam 429 (%81,5) hastada 787 ilaç-ilaç etkileşimi tespit edildi. Ortalama etkileşim sayısı 3,89 ± 3,6, etkileşim A için %15,2 (n = 81), etkileşim B için %16,2 (n = 85), etkileşim C için %69,8 (n = 367), %47,9 (n = 252) idi. etkileşim D için ve etkileşim X için %0,4 (n = 2). En sık görülen etkileşim asetilsalisilik asit ve insülin ile metformin ve anjiyotensin dönüştürücü enzim inhibitörleri arasında bulundu. Diyabetik hastalarda hem polifarmasi oranı hem de ilaç-ilaç etkileşimi oranı yüksektir. En sık görülen etkileşim türü C tipi ve D tipi ilaç-ilaç etkileşimleridir. Diyabet hastalarının tedavisinde ilaç-ilaç etkileşimlerine dikkat edilmelidir.

Anahtar Kelimeler

• Diabetes Mellitus
• İlaç ilaç etkileşimleri
• polifarmasi

Polypharmacy and drug-drug interactions among patients with Diabetes Mellitus

Öz

Background: Diabetes mellitus is a chronic disease. The aim of our study was to evaluate drug- drug interactions and polypharmacy in diabetic patients. Methods: Patients with type 2 diabetes attending our internal medicine and endocrinology policlinics from April 2019 to July 2019 were included to the study. It was designed as a prospective, descriptive and cross-sectional study. The socio-demographic characteristics of diabetic individuals, the drugs they use in the treatment of diabetes, and other accompanying diseases were evaluated according to the ATC classification. In this study, interactions between multiple drugs and polypharmacy were examined. Results: The study population consisted of 526 patients between the ages of 18-87/years (59 ± 11). 69.6% of the patients were women.83.8% of the patients had chronic diseases accompanying diabetes. The most common chronic diseases were hypertension (53.6%), hyperlipidemia (41.4%) and coronary artery disease (27.2%), respectively. 45.01% of the patients were using five or more drugs. The mean number of drugs was found to be 4.49 ± 1.93. Among the drugs used by the patients, 787 drug-drug interactions were found in a total of 429 (81.5%) patients. The average number of interactions was 3.89 ± 3.6 for interaction A 15.2% (n = 81), 16.2% (n = 85) for interaction B, 69.8% (n = 367) for interaction C was, 47.9% (n = 252) for interaction D, and 0.4% (n = 2) for interaction X. The most frequent interaction was found between acetylsalicylic acid and insulin and metformin and angiotensin converting enzyme inhibitors. Conclusions: Both the polypharmacy rate and drug-drug interaction rate are high in diabetic patients. The most common type of interaction is type C and type D drug-drug interaction. Attention should be paid to drug-drug interactions in the treatment of diabetes patients.

Anahtar Kelimeler

• drug-drug interactions
• polypharmacy
• diabetes

Kaynakça

1. Amin M, Uksomboon N. Pharmacotherapy of type 2 diabetes mellitus: an up date on drug-drug interactions. Drug Saf 2014;37: 903-9.
2. Santos AC, Willumsen J, Meheus F, Ilbawi A, Bull FC. The cost of inaction on physical inactivity to public health-care systems: a population-attributable fraction analysis. Lancet Glob Health. 2023 ;11(1):32-9. doi: 10.1016/S2214-109X(22)00464-8.
3. Freeman J. Management of hypoglycemia in older adults with type 2 diabetes. Postgrad Med. 2019 ;131(4): 241-50. doi: 10.1080/00325481.2019.1578590.
4. Mohammed MA, Harrison J, Milosavljevic A et al. Attitude towards deprescribing and its association with frailty and complexity of medication regimen: A survey of older inpatients in a district health board in New Zealand. BMC Geriatr. 2023; 23(1):166. doi: 10.1186/s12877-023-03878-2. PMID: 36959598; PMCID: PMC10035261.
5. Rehman S, Choi M, Choe K et al. Interactions between herbs and antidiabetics: an overview of themechanisms, evidence, importance and management. Arch Pharm Res.2015;38: 1281-98.
6. Turgeon J, Michaud V, Steffen L. The Dangers of Polypharmacy in Elderly Patients. JAMA Intern Med. 2017;1:177(10):1544. doi: 10.1001/jamainternmed.2017.4790. PMID: 28973278.
7. Viktil KK, Blix HS, Moger TA et al.. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol 2007; 63(2): 187-95.
8. Goren Z. Klinik Farmakolojinin İlaç Bilgilendirme Hizmetindeki Yeri. TFD-KFÇG E-bülteni 2012; 60: 1-5.

9. Aktay G, Hamit Hancı İ, Balseven A. İlaç Etkileşimleri ve Hekim Sorumluluğu. Sürekli Tıp Eğitimi Dergisi.2003;12(7):261-4.
10. Kayaalp O. Rasyonel Tedavi Yönünden Tıbbi Farmakoloji. 12. Baskı. Ankara,Pelikan Yayıncılık; 2009.
11. Pınar N. Ülkemizde İlaç Harcamaları. İnönü Üniversitesi Tıp Fakültesi Dergisi 2012; 19(1): 59-65
12. Gnjidic D, Hilmer SN, Blyth FM et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65(9):989-95. doi: 10.1016/j.jclinepi.2012.02.018.
13. Onder G, Petrovic M, Tangiisuran B et al. Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65 years or older: the GerontoNet ADR risk score. Arch Intern Med. 2010;12;170(13):1142-8. doi: 10.1001/archinternmed.2010.153. PMID: 20625022.
14. Van Leeuwen RWF, Brundel DHS, Neef C, et al. Prevalence of potential drug-druginteractions in cancer patients treated with oral anticancer drugs. Br J Cancer, 2013; 108(5): 1071–8.
15. Vitoi NC, Fogal AS, Nascimento CM et al. Prevalence and associated factors of diabetes in the elderly population in Viçosa, Minas Gerais, Brazil. Rev Bras Epidemiol 2015; 18(4): 953-65.
16. Moraes SA, Freitas IC, Gimeno SG et al. Prevalência de diabetes mellitus e identificação de fatores associados em adultos residentes em área urbana de Ribeirão 14-Preto, São Paulo, Brasil, 2006: Projeto OBEDIARP [Diabetes mellitus prevalence and associated factors in adults in Ribeirão Preto, São Paulo, Brazil, 2006: OBEDIARP Project]. Cad Saude Publica. 2010 ;26(5):929-41. Portuguese. doi: 10.1590/s0102-311x2010000500015. PMID: 20563393.
17. Araújo MF, SantosAlves PJ, Veras VS et al. Drug interactions in Brazilian type 2 diabetes patients. Int J NursPract 2013; 19(4): 423-30.
18. Freeman J and Gross B. Potential drug interactions associated with treatments for type 2 diabetes and its comorbidities: a clinical parmacology review. Expert Rev Clin Pharmacol.2012;5: 31-42.
19. Silva MRRD, Diniz LM, Santos JBRD et al. Drug utilization and factors associated with polypharmacy in individuals with diabetes mellitus in Minas Gerais, Brazil. Cien Saude Colet. 2018;23(8):2565-74. Portuguese, English. doi: 10.1590/1413-81232018238.10222016. PMID: 30137126.
20. Prado MA, Francisco PM, Barros MB. Diabetes in the elderly: drug use and the risk of drug interaction. Ciencia&SaudeCol. 2016;21: 3447‐58
21. Indu R, Adhikari A, Maisnam I et al. Polypharmacy and comorbidity status in the treatment of type 2 diabetic patients attending a tertiary care hospital: An observational and questionnaire-basedstudy. Perspect Clin Res 2018;9: 139-44.
22. Acharya KG, Shah KN, Solanki ND et al. Evaluation of antidiabetic prescriptions, cost and adherence to treatment guidelines: A prospective, cross-sectionalstudy at a tertiary care teaching hospital. J Basic ClinPharm 2013; 4: 82-7.
23. Upadhyay DK, Palaian S, Ravi SP et al. Prescribing pattern in diabetic outpatients in a tertiary care teaching hospital in Nepal. J Clin Diagn Res 2007; 3: 248-55.
24. Feng X, Tan X, Riley B et al. Polypharmacy and Multimorbidity Among Medicaid Enrollees: A Multistate Analysis. Popul Heal Manag, 2018;21(2): 123–29. doi: 10.1089/pop.2017.0065 25. Golchini N, Frank SH, Vince A, Isham L, Meropol SB. Polypharmacy in the elderly. J Res Pharm Pract 2015;4:85-8.
25. Golden, AG, Preston, RA, Barnett, SD et al. . Inappropriate medication prescribing in home bound older adult. Journal of the American Geriatrics Society.1997; 47(8): 948-53.
26. Broderick E. Prescribing patterns for nursing home residents in the U.S. The Reality and the vision. Drugs& Aging, 1997; 11(4):255-60.
27. Raja S, Mohapatra S, Kumar JS, et al. Prescription patterns of hypolipidaemic drugs in a tertiary care teaching hospital of Southern India. J Clin Diagn Res 2014;8(4) : HC01- HC03.
28. Say Sahin D, Özer Ö, Zubaroğlu Yanardağ M. Yaşlı Bireylerin İlaç Kullanımına İlişkin Davranışlarının Sosyo-Demografik Değişkenler Açısından İncelenmesi. Mehmet Akif Ersoy Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2018; 6(1): 15-25.
29. Ibrahim IA, Kang E, Dansky KH. Polypharmacy and possible drug-drug interactions among diabetic patients receiving home health care services. Home Health Care Serv Q. 2005;24(1-2): 87-99. doi: 10.1300/J027v24n01_07. PMID: 16236661.
30. Glynn, RJ, Monane, M, Gurwitz JH et al. Aging, Comorbidity, and Reduced Rates of Drug Treatment for Diabetes Mellitus. Journal of Clinical Epidemiology, 1999; 52(8): 781-90.
31. Adhikari A, Indu R, Bhowal T et al. Evaluation of adverse effects due to antidiabetic and cardiovascular drugs in a tertiary care hospital in Kolkata, West Bengal, India. Int J Pharm Sci Res. 2016;7: 3101-16.
32. Dookeeram D, Bidaisee S, Paul JF et al. Polypharmacy and potential drug-drug interactions in emergency department patients in the Caribbean. Int J Clin Pharm. 2017 ;39(5):1119-27. doi: 10.1007/s11096-017-0520-9.
33. Marusic S, Bacic-Vrca V, Obreli Neto PR et al. Actual drug-drug nteractions in elderly patients discharged from internal medicine clinic: A prospective observational study. Eur J Clin Pharmacol, 2013; 69(9): 1717–24.
34. Broderick E. Prescribing patterns for nursing home residents in the U.S. The Reality and the vision. Drugs& Aging, 1997; 11(4): 255-60.
35. Ikäheimo I, Karjalainen M, Tiihonen M et al. Clinically relevant drug-drug interactions and the risk for drug adverse effects among home-dwelling older persons with and without type 2 diabetes. J Clin Pharm Ther. 2019;44(5):735-1. doi: 10.1111/jcpt.12854.
36. Ascı H, Sönmez Y, Cankara FN et al. Investigation of the presence of potential drug-drug interactions in the adult intensive care unit: a retrospective study. Med J SDU, 2016; 23(3): 87–6.
37. Johnell K, Klarin I. The relation ship between number of drugs and potential drug-drug interactions in the elderly: a study of over 600,000 elderly patients from the Swedish Prescribed Drug Register. Drug Saf, 2007; 30(10): 911–8.
38. Savran M, Aşçı H. Evaluation of Drug Profiles in Elderly Living in Nursing Homes: Drug-Drug Interaction Analysis. Med J SDU. 2018;25(4):361-9. doi:10.17343/sdutfd.403187.
39. Zaman Huri H, Chai Ling L. Drug-related problems in type 2 diabetes mellitus patients with dyslipidemia. BMC Public Health 2013; 13:1192. https://doi.org/10.1186/1471-2458-13-1192