Objective In this study, we utilized a large-scale clinical database to evaluate the relationship between polypharmacy and adverse outcomes among type 2 diabetes patients in rural Montana to inform strategies that improve adherence, reduce preventable complications, and promote equitable diabetes care in underserved regions.

Research Design and Methods 591 patients from the Big Sky Care Connect Database (BSCC) with type 2 diabetes and medication history were stratified into 3 cohorts based on prescribed number of medications: (1-4 medications, non-polypharmic), (5-9 medications, polypharmic), and (≥10 medications, hyperpolypharmic). Each cohort was examined for Major Adverse Cardiovascular Events (MACE) and Diabetes Complication Severity Index (DCSI). Descriptive statistics, multivariate logistic regressions, linear regression, and Poisson regression analyses were performed.

Results Medication count was associated with male gender (β = -2.1341, p < 0.001). Both medication count (IRR 1.06 per additional medication, p < 0.001) and age (IRR 1.03 per year, p < 0.001) were significant predictors of MACE. Neuropathy and nephropathy prevalence was statistically significant (p < 0.001) across patient cohorts and increased with medication count.

Conclusions A high prevalence of polypharmacy was observed in type 2 diabetic patients in rural Montana. Polypharmacy was found to be a significant predictor of MACE and increased the odds of nephropathy in this study. While disease severity contributes to higher medication counts, these findings highlight the need for medication review and cross-provider management to minimize adverse outcomes.

Article Highlights Why did we undertake this study?

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The authors have declared no competing interest.

This study was supported by the National Institutes of Health (P2GM152335) and Weissman Hood Institute Institutional Funds.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Data obtained by investigators was from Big Sky Care Connect. Big Sky Care Connect (BSCC) is a nonprofit formed in 2018 to respond to the need for a statewide health information exchange (HIE) to enhance clinical care in communities across Montana. Data was deidentified of personally identifiable information (PII) in accordance with HIPAA guidelines prior to receipt and analysis and the research team had no access to direct or indirect identifiers, nor any means to re-identify individuals.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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The data analyzed in the current study are available from the corresponding author upon reasonable request.