A PROSPECTIVE STUDY ON EVALUATING POLY PHARMACY & ITS ASSOCIATED FACTORS IN TYPE-2 DIABETES WITH GASTROPARESIS
DOI:
https://doi.org/10.53555/7n0ate66Keywords:
Polypharmacy, Type 2 diabetes, Gastroparesis, Multimorbidity, Drug interactionsAbstract
Polypharmacy, defined as the concurrent use of ≥5 medications, remains highly prevalent in type 2 diabetes mellitus (T2DM) patients complicated by gastroparesis—a neuropathic motility disorder stemming from chronic hyperglycemia-induced vagal damage—primarily due to escalating multimorbidity demands for antidiabetics, antihypertensives, prokinetics, statins, and analgesics. This prospective observational study rigorously evaluated its prevalence, sociodemographic/clinical determinants, therapeutic patterns, safety profile, adherence metrics, and quality-of-life impacts in a real-world cohort of 140 adults (aged 30-70 years; 64.3% female, 57.1% rural) managed at the diabetes outpatient department of RVS Hospital, Chittoor, India, over a 6-month period (November 2025–April 2026).
Prevalence reached 74.7% (95% CI: 67.2-81.2%; n=112/140), encompassing hyper-polypharmacy (≥10 drugs) in 18.7% (n=28) with a mean of 7.2 ± 2.4 medications per patient—substantially surpassing global T2DM benchmarks (40-60%) and regional studies (e.g., Ethiopian 49%, Saudi 60%). Multivariate logistic regression identified key independent factors: advanced age (>60 years; OR 6.5, 95% CI 2.4-17.3, p=0.001), prolonged diabetes duration (13.8 ± 5.2 vs. 8.4 ± 4.1 years; p=0.001), multimorbidity (≥3 comorbidities in 85.7% vs. 39.5%; OR 8.2, 95% CI 3.1-21.7), suboptimal glycemic control (HbA1c 8.5 ± 1.8% vs. 7.4 ± 1.4%; p=0.002), alongside rural residence and female predominance amplifying regimen complexity.
Dominant classes included antidiabetics (94.7%; metformin 82%, glimepiride 65.3%, insulin 28%), antihypertensives (78.7%; atenolol 52%), prokinetics (58%; domperidone 45.3%), and lipid-lowering agents (62%; atorvastatin 52%), with gastroparesis uniquely inflating pill burden via erratic absorption risks. Adverse sequelae were stark: major/minor DDIs in 65.2% vs. 13.2% (p=0.001; e.g., glimepiride-β-blocker hypoglycemia potentiation), probable/definite ADRs in 27.7% vs. 5.3% (p=0.001), hypoglycemia in 21.4%, poor adherence (Morisky-8) in 51.8% from overload, hospitalizations in 67.9% vs. 34.2%, severe gastroparesis (GCSI ≥3) in 40.2% vs. 21.1% (p=0.02), and QoL erosion (EQ-5D VAS 52 ± 15 vs. 68 ± 12; mobility OR 3.4, anxiety OR 4.1).
Multimorbidity emerges as the cardinal driver in this high-burden Indian context, mandating pharmacist-led deprescribing, rationalization (glycemic prioritization, prokinetic minimization), and integrated care models to avert modifiable crises and enhance equity in resource-constrained settings.
References
1.AlOlaiwi, L. A., AlHarbi, T. J., & Tourkmani, A. M. (2018). Prevalence of cardiovascular autonomic neuropathy and gastroparesis symptoms among patients with type 2 diabetes who attend a primary health care center. PloS one, 13(12), e0209500. https://doi.org/10.1371/journal.pone.0209500
2.Li, L., Wang, L., Long, R. et al. Prevalence of gastroparesis in diabetic patients: a systematic review and meta-analysis. Sci Rep 13, 14015 (2023). https://doi.org/10.1038/s41598-023-41112-6.
3.Tamene, F.B., Zeleke, T.K., Desalew, A.F. et al. Polypharmacy and associated factors among patients with type two diabetes mellitus with comorbidity: a multicenter cross-sectional study in Northwest Ethiopia. BMC Endocr Disord 25, 188 (2025). https://doi.org/10.1186/s12902-025-02011-1
4.Salh, H. J. H., Aziz, T. A., Mahwi, T. O., Hussen, N. H., & Aziz, D. F. (2025). The Relation Between Polypharmacy, Potentially Inappropriate Medications, Organ Function, and Quality of Life in Elderly Patients with Type 2 Diabetes. Hospital pharmacy, 00185787251337592. Advance online publication. https://doi.org/10.1177/00185787251337592
5.Al-Musawe, L., Torre, C., Guerreiro, J. P., Rodrigues, A. T., Raposo, J. F., Mota-Filipe, H., & Martins, A. P. (2020). Polypharmacy, potentially serious clinically relevant drug-drug interactions, and inappropriate medicines in elderly people with type 2 diabetes and their impact on quality of life. Pharmacology research & perspectives, 8(4), e00621. https://doi.org/10.1002/prp2.621
6.Choung, R. S., Locke, G. R., 3rd, Schleck, C. D., Zinsmeister, A. R., Melton, L. J., 3rd, & Talley, N. J. (2012). Risk of gastroparesis in subjects with type 1 and 2 diabetes in the general population. The American journal of gastroenterology, 107(1), 82–88. https://doi.org/10.1038/ajg.2011.310.
7.AlHarbi, T. J., & Tourkmani, A. M. (2018). Prevalence of cardiovascular autonomic neuropathy and gastroparesis symptoms among patients with type 2 diabetes PloS one, 13(12), e0209500.
8.Amarnath, Hussen, N A Polypharmacy effect on Potentially Inappropriate Medications, Organ Function, and Quality of Life in Elderly Patients with Type 2 Diabetes. Pharmacology research & perspectives, 8(4), e00621.
9.Dobrica, Long (2019) Gastro and its associated factors among patients with type two diabetes mellitus with comorbidity: a multicenter cross-sectional study :a systematic review and meta-analysis. Sci Rep 13, 2405.
10.Peron et al.'s (2015) Potentially Inappropriate Medications and Quality of Life in Geriatric Patients with Type 2 Diabetes. Pharmacology research & perspectives, 8(4), e00621 https://doi.org/10.1186/s49158-025-02015-1
11.Asghar et al. (2023)Prevalence of cardiovascular autonomic neuropathy and gastroparesis symptoms among patients with type 2 diabetes who attend a primary health care center. PloS one, 13(12), e0209500. https://doi.org/10.1371/journal.pone.0209500
12.Talley et al. (2001) quality of life evaluating in diabetes complication patients The American journal of gastroenterology , BMC Endocr Disord 49, 199.
