We have had this discussion before, polypharmacy. This continues to be a hot button for our centers as we all know medications can increase the risk of a negative outcome. Aside from the actual number of medications being prescribed, we should also be concerned about what the possible side effects of the medications are. For example, a common complication of some medications is their potential to disrupt glycemic control. Take a look at the examples below:

• Glucocorticoids (Steroids) – These medications can and often do lead to new-onset diabetes (steroid-induced diabetes).
• Antipsychotic therapy – Between 15% and 72% of people who take second-generation antipsychotics experience weight gain of 7% or more which is often associated with the risk of developing type 2 diabetes.
• Thiazide diuretics – Commonly used for the management of hypertension can cause hypokalemia which is thought to lead to a decrease in insulin secretion.
• Statin Therapy – The overall incidence of diabetes is between 9% and 12% when on statin therapy.
• Beta Blockers – Prescribed for the management of hypertension and cardiac conditions, are associated with increases in A1c.

Many of our residents have been on some of these medications for years and physicians continue to treat based on historical information. A great example is statins. We have had this discussion in the past, risk/benefit, yes, elevated cholesterol levels can be dangerous. However, as we age, our bodies do not process medications as well as we did when we were younger and there is a risk of toxicity.

It really is time to review each resident’s medication regime, have a sit down with your medical director, prescribers, and your pharmacy representative.  Discuss this information, review lab results for residents with abnormal glucose levels, are they using any of the medications listed above? Are you adding medication to control blood glucose levels when maybe you should eliminate a medication that is causing the abnormal levels? The chicken or the egg, right? First do no harm, drug-induced diabetes is potentially reversible and polypharmacy is risky business! Stay well and stay informed!