Evidence map›Paper›PMID 33608768›Full record

ArticleDiabetologia2021

The association of polypharmacy and high-risk drug classes with adverse health outcomes in the Scottish population with type 1 diabetes.

Andreas Höhn, Anita Jeyam, Thomas M Caparrotta, Stuart J McGurnaghan, Joseph E O'Reilly, Luke A K Blackbourn, Rory J McCrimmon, Graham P Leese, John A McKnight, Brian Kennon and 6 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Diabetologia, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.9field-weighted citation impact, top 26% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 11 citations in OpenAlex.

  1. Article
  2. Article
  3. Observational
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 8 institutions in 1 country.

Andreas HöhnMRC Institute of Genetic and Molecular Medicine, University of Edinburgh, Edinburgh, UK. andreas.hohn@igmm.ed.ac.uk.ORCID https://orcid.org/0000-0002-7170-1205
Anita JeyamMRC Institute of Genetic and Molecular Medicine, University of Edinburgh, Edinburgh, UK.ORCID https://orcid.org/0000-0001-8701-0233
Thomas M CaparrottaMRC Institute of Genetic and Molecular Medicine, University of Edinburgh, Edinburgh, UK.ORCID https://orcid.org/0000-0001-9009-9179
Stuart J McGurnaghanMRC Institute of Genetic and Molecular Medicine, University of Edinburgh, Edinburgh, UK.ORCID https://orcid.org/0000-0002-3292-4633
Joseph E O'ReillyMRC Institute of Genetic and Molecular Medicine, University of Edinburgh, Edinburgh, UK.ORCID https://orcid.org/0000-0001-9775-253X
Luke A K BlackbournMRC Institute of Genetic and Molecular Medicine, University of Edinburgh, Edinburgh, UK.ORCID https://orcid.org/0000-0003-4234-8040
Rory J McCrimmonDivision of Molecular and Clinical Medicine, University of Dundee, Dundee, UK.ORCID https://orcid.org/0000-0002-3957-1981
Graham P LeeseNinewells Hospital, Dundee, UK.ORCID https://orcid.org/0000-0003-0570-5678
John A McKnightWestern General Hospital, NHS Lothian, Edinburgh, UK.ORCID https://orcid.org/0000-0002-8214-7625
Brian KennonQueen Elizabeth University Hospital, Glasgow, UK.ORCID https://orcid.org/0000-0002-4963-5870
Robert S LindsayInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.ORCID https://orcid.org/0000-0002-9868-5217
Naveed SattarInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.ORCID https://orcid.org/0000-0002-1604-2593
Sarah H WildUsher Institute of Population Health Sciences and Informatics, Centre for Population Health Sciences, School of Molecular, Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK.ORCID https://orcid.org/0000-0001-7824-2569
Paul M McKeigueUsher Institute of Population Health Sciences and Informatics, Centre for Population Health Sciences, School of Molecular, Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK.ORCID https://orcid.org/0000-0002-5217-1034
Helen M ColhounMRC Institute of Genetic and Molecular Medicine, University of Edinburgh, Edinburgh, UK.ORCID https://orcid.org/0000-0002-8345-3288
Scottish Diabetes Research Network (SDRN) Epidemiology Group
Institute of Genetics and Cancer · GBGlasgow Centre for Population Health · GBUniversity of Glasgow · GBNHS Fife · GBNHS Lothian · GBNinewells Hospital · GBQueen Elizabeth University Hospital · GBUniversity of Dundee · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aims/hypothesisThe aim of this work was to map the number of prescribed drugs over age, sex and area-based socioeconomic deprivation, and to examine the association between the number of drugs and particular high-risk drug classes with adverse health outcomes among a national cohort of individuals with type 1 diabetes.

methodsUtilising linked healthcare records from the population-based diabetes register of Scotland, we identified 28,245 individuals with a diagnosis of type 1 diabetes on 1 January 2017. For this population, we obtained information on health status, predominantly reflecting diabetes-related complications, and information on the total number of drugs and particular high-risk drug classes prescribed. We then studied the association of these baseline-level features with hospital admissions for falls, diabetic ketoacidosis (DKA), and hypoglycaemia or death within the subsequent year using multivariate Cox proportional hazards models.

resultsNot considering insulin and treatment for hypoglycaemia, the mean number of prescribed drugs was 4.00 (SD 4.35). The proportion of individuals being prescribed five or more drugs at baseline consistently increased with age (proportion [95% CI]: 0-19 years 2.04% [1.60, 2.49]; 40-49 years 28.50% [27.08, 29.93]; 80+ years 76.04% [67.73, 84.84]). Controlling for age, sex, area-based socioeconomic deprivation and health status, each additional drug at baseline was associated with an increase in the hazard for hospitalisation for falls, hypoglycaemia and death but not for DKA admissions (HR [95% CI]: falls 1.03 [1.01, 1.06]; DKA 1.01 [1.00, 1.03]; hypoglycaemia 1.05 [1.02, 1.07]; death 1.04 [1.02, 1.06]). We found a number of drug classes to be associated with an increased hazard of one or more of these adverse health outcomes, including antithrombotic/anticoagulant agents, corticosteroids, opioids, antiepileptics, antipsychotics, hypnotics and sedatives, and antidepressants.

conclusionsPolypharmacy is common among the Scottish population with type 1 diabetes and is strongly patterned by sociodemographic factors. The number of prescribed drugs and the prescription of particular high-risk drug classes are strong markers of an increased risk of adverse health outcomes, including acute complications of diabetes.

Indexed as

Accidental FallsAdolescentAdultAgedAged, 80 and overChildChild, PreschoolDatabases, FactualDiabetes Mellitus, Type 1FemaleHumansHypoglycemic AgentsInfantInfant, NewbornInsulinMaleHypoglycemic AgentsInsulinAcute complications of diabetesAgeingDKAHigh-risk prescribingHypoglycaemiaMedication reviewsMortalityMultimorbidityPolypharmacyType 1 diabetes

Identifiers

PMID33608768
PMCPMC8099818
OpenAlexW3133198251

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.