Diabetics could be in for some bad news.
All medications come with side effects, from benign to fatal, which can affect a user’s health journey and whether they need additional medications to manage adverse effects.
One recent study revealed that common diabetes medications are setting off a cascade of prescriptions that leave older adults taking drugs to treat the side effects of other drugs.
The estimated 40 million people who have diabetes may be prescribed a medication to manage blood sugar levels.
Published in BMC Medicine, researchers analyzed two large routine healthcare databases of more than 387,000 participants to determine how often those with type 2 diabetes are prescribed another medication to manage side effects of the first drug.
The researchers looked for whether one medication was more often started after, rather than before, another.
Of 12 medication pairings examined, the researchers identified seven potential prescribing cascades, or the addition of an unnecessary second drug to manage side effects that are mistaken for a new medical condition.
Two common diabetes medications — sodium-glucose cotransporter-2 (SGLT2) inhibitors and thiazolidinediones — were identified as part of these prescribing cascades.
SGLT2 inhibitors prevent the kidneys from reabsorbing glucose back into the bloodstream, removing the extra sugar through urine, with reported side effects like peeing more often and dizziness.
Since the inhibitors increase urination and sugar in the urine, the risk of yeast infections also increases.
The researchers found that sodium-glucose cotransporter-2 inhibitors were often followed by antibiotics for urinary tract infections, antifungals and overactive bladder medications.
Meanwhile, thiazolidinediones help the body use insulin more efficiently, with adverse effects including swelling in the legs and ankles or weight gain, as well as an increased risk of broken bones, heart failure, liver damage or low blood sugar.
Those who took thiazolidinediones were often then prescribed loop diuretics, or “water pills” that help the body get rid of extra salt and water by increasing urination.
Other medications commonly used to treat diabetes were also found in the prescribing cascades, including statins.
Statins can cause lower urinary tract symptoms and sleep disturbance, leading to overactive bladder medications or hypnotics being prescribed afterwards.
Meanwhile, calcium channel blockers, often prescribed to manage high blood pressure in diabetics, can bring about lower-extremity swelling.
The study found that these medications were often followed with a prescription for diuretics to manage swelling.
Rather than prescribing a potentially unnecessary second medication, researchers suggest recognizing the adverse drug reactions could lead to stopping or modifying the first medication.
This, in turn, could reduce the amount of work patients must put in towards treatment and the number of medications to manage.
