Polifarmácia e interações medicamentosas potenciais no Diabetes Mellitus: linha de base do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil)

Abstract

Introduction: Diabetes Mellitus (DM) is a very prevalent disease in the world. Its treatment is complex and is often associated with the use of multiple medications due to associated comorbidities, and consequently the risk of drug interactions (MI) increases. Objective: To estimate the prevalence of polypharmacy and to evaluate potential drug interactions among participants with diagnosis of DM. Methods: This was a cross-sectional study using ELSABrazil baseline data from August 2008 to December 2010. The population studied comprised participants with diagnosis of diabetes (n = 1,473), and five participants were excluded from the study, because there were no data about antihypertensive use (n = 1,468 total). Polypharmacy was defined as use of five or more drugs and all drugs were coded according to the Anatomical Therapeutic Chemical (ATC) classification. The profiles were drawn according to the demographic and socioeconomic characteristics, life habits (smoking, alcohol use and physical activity). The drug interactions were evaluated according to their severity, according to drugs.com: mild, moderate or severe. Mean (standard deviation), median (interquartile ranges) or proportions of the characteristics of the population studied were described, and the chi-square and Fisher's Exact tests were used to assess whether polypharmacy differed between categories. P value <0.05 was considered statistically significant. The analyzes were performed in Stata software version 14.0. The ELSA-Brasil study was approved by the Research Ethics Committees of the six participating centers. Results: Of the total ELSA-Brasil participants (n = 15,105), we studied 1,468 (9.7%) who had a diagnosis of DM and 601 were in polypharmacy. Among those who were polypharmacy, the majority were women (54.6%), 55-64 years old (41.3%), with a complete upper level (42.6%) and predominantly white self-reported skin color (45, 9%) and the average number of drugs consumed was six. The prevalence of hypertension, dyslipidemia, obesity, cardiovascular disease and depression among those who were in polypharmacy were 90.4%, 75.9%, 44.8%, 11.8% and 6.8, respectively . In relation to the pharmacological groups presented, the most frequent were the medications that act in the cardiovascular system (95.8%) and then those that work in the digestive system and metabolism (94.5%). Among the specific drugs for DM treatment, it was observed that biguanide is the most used class of antidiabetics (80.2%), followed by sulfonylureas (38.8%) and insulin (10%). Among participants with DM and polypharmacy, the percentage of mild, moderate and severe potential interactions was, respectively, 6.0%, 32.4% and 2.0%. Among severe MI, the most frequent were the association of insulin + metformin (23.1%) and insulin + angiotensin converting enzyme inhibitors (17.6%). Conclusions: This study, conducted with participants with a previous diagnosis of DM in the baseline of a large Brazilian cohort, showed a high prevalence of polypharmacy, as well as potential drug interactions, especially those classified as moderate. Polypharmacy may, in part, be justified by the high frequency of comorbidities associated with DM.