4.3 Implication for policy and practice
Polypharmacy can be considered as an indicator for medication burden, although it does not indicate inappropriate medication. In older people with diabetes, we observed a small decrease in patients with any PIM among an increasing population with polypharmacy. Despite this trend, more than a quarter of older people with diabetes and polypharmacy received at least one PIM. Notably, in the middle-aged group the prevalence of PIM appears to be higher and did not decrease. One should be aware, however, that comparing the absolute prevalence rates between the groups is restricted by the use of different PIM lists for different age groups. Importantly, at individual PIM level many PIMs were not decreasing in older nor middle-aged people with diabetes.
It is therefore important not only to focus on older patients with PIM. To decrease inappropriate polypharmacy, attention should be paid to specific PIMs and to specific high-risk populations, such as those with diabetes. Multifaceted, patient-centered interventions have shown to be effective at reducing inappropriate medication in the general older population [34,35]. Developing such interventions for middle-aged people with diabetes may be necessary. More research is needed to assess the benefits versus harms caused by PIMs in middle-aged populations.