Objective To analyze the situation and factors influencing potentially inappropriate medication(PIM)in hospitalized elderly patients with type 2 diabetes(T2DM).Methods This study conducted a single-center observational study.Patients aged ≥65 years old with T2DM who were hospitalized between June 2019 and May 2023 were consecutively selected based on the inclusion criteria.The evaluation of polypharmacy and PIM was done using the Beers criteria(2019 version).Additionally,comprehensive geriatric assessment was used to evalu-ate the patient's functional status and geriatric syndromes.Multivariate logistic regression analysis was employed to analyze the factors influencing PIM in elderly patients with T2DM.Results In this study,426 hospitalized elderly patients with T2DM were included.Out of these patients,190 cases(44.6％)were males,with ages ranging from 65 to 93 years and a median age of 74 years.Among all the patients,343 cases(80.5％)were using multiple medications(polypharmacy).Based on the Beers criteria(2019 version),it was found that 232 patients(54.5％)had PIMs,with a total of 452 occurrences.The top five categories of PIM drugs with the highest inci-dence were diuretics,benzodiazepines,aspirin for primary prevention of cardiovascular events and colon cancer,pro-ton pump inhibitors,and long-acting sulfonylureas.The PIMs were further categorized into 172 occurrences of drug-related PIM,44 occurrences related to diseases or symptoms,206 occurrences that should be used with caution in the elderly,22 occurrences of potentially clinically important drug-drug interactions to be avoided in older adults,and 8 occurrences of PIMs to be reduced/avoided according to renal function.Compared to elderly patients with T2DM without PIM,patients with PIM exhibit certain characteristics.They tend to be older,had a greater number of chronic diseases,and had a higher age-adjusted Charlson comorbidity index.Additionally,they had a higher propor-tion of long-term medication types and polypharmacy,and lower handgrip strength.The proportion of patients unable to complete the tandem stance was significantly higher among those with PIM.Furthermore,ADL and IADL scores were lower,and the proportion of patients requiring assisted walking was significantly higher in comparison to pa-tients without PIM.Hemoglobin,total cholesterol,and low-density lipoprotein cholesterol levels were lower,while creatinine,uric acid,and high-sensitivity C-reactive protein levels were higher among patients with PIM.These differences were statistically significant(P＜0.05)in all cases.The results of the multivariate logistic regression analysis indicated that the numbers of chronic diseases(OR=1.177,95％CI:1.043-1.328,P=0.008),the types of long-term medication(OR=1.124,95％CI:1.033-1.223,P=0.007),and combined polypharmacy(OR=2.747,95％CI:1.340-5.629,P=0.006)were significant influencing factors of PIM in elderly patients with T2DM.Conclusions The prevalence of polypharmacy and PIM is high among hospitalized elderly patients with T2DM.Elderly patients with T2DM who have multiple chronic conditions and polypharmacy require special at-tention to ensure appropriate medication use.It is important to carefully review the medication regimen and consider medication reconciliation by identifying any potential inappropriate medications.
Diabetes mellitus,type 2PolypharmacyInappropriate prescribingPotentially inappropriate medi-cation listRoot cause analysisAged
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