Remission of polypharmacy in patients with diabetes after obesity surgery

Abstract

Introduction: Obesity contributes to increased risk of developing comorbidities that require polypharmacy (taking ≥5 medicines) [1], namely type 2 diabetes (T2D) [2], increasing the risk of drug-related problems. Bariatric surgery (BS) has emerged as the most effective treatment for obesity and T2D remission [3–5]. Objective: The goal of this study was to evaluate the impact of BS in the remission of polypharmacy in patients with T2D. Methods: A retrospective study included collecting clinical data and medication in use from patients with T2D before surgery (m0) and follow-up visits after BS. Obesity remission was considered when body mass index (BMI) <30Kg/m². T2D remission was when no antidiabetic drugs were administered plus HbA1c <6,5% and/or fasting plasma glucose (FPG) <126mg/dL. Results: The sample included 78 patients (83.3% female; age: 51.5±9.8 years old). At baseline, mean body weight (BW) was 107.4±17.5Kg and BMI 41.7±5.3Kg/m². Average HbA1c was 7.0±1.6%, FPG was 133.7±54.4mg/dL, and around 2/3 were polymedicated (average use of 6.7±3 medicines, 1.7 for T2D). Individuals in polypharmacy were older (p=0.0055), had higher BW (p=0.02), and were taking more medicines for T2D (1.8±0.8, p=0.009) than non-polymedicated individuals. One year after BS (m12), BW, BMI, HbA1c and FPG were decreased compared to m0 (p<0.0001). At m12, obesity and T2D remission was 52.6% and 53.8%, respectively. The mean number of overall medicines taken decreased (1.9±3.1, p<0.0001), including the number of antidiabetic medicines (0.2±0.5, p<0.0001), representing that only 10.3% of the patients were polymedicated at m12. A decrease of patients taking medication for hypertension (85.9% m0 vs. 26.9% m12), lipid disorders (57.7% m0 vs. 14.1% m12) and depression/anxiety (30.8% m0 vs. 11.5% m12) was also observed. Conclusion: Changes after BS contemplated a reduction in the number of medicines taken, reducing the risk of drug-related problems, which suggests that BS is a suitable strategy for polypharmacy remission.