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The Influence of Polypharmacy on Type 2 Diabetes Adverse Cardiovascular Outcomes in a Rural Cohort
Jennifer W Li1, Lilia A Crew1,2, Trisha M Cox2
1Touro College of Osteopathic Medicine Montana.
Medrxiv : the Preprint Server for Health Sciences
|April 10, 2026
Summary
Polypharmacy in rural Montana type 2 diabetes patients is common and predicts adverse cardiovascular events and kidney complications. Medication review is crucial for managing these risks in underserved populations.
Area of Science:
- Clinical Medicine
- Pharmacology
- Public Health
Background:
- Polypharmacy is prevalent among type 2 diabetes patients, particularly in rural and underserved areas.
- Managing multiple medications in this population presents challenges for adherence and adverse event prevention.
Purpose of the Study:
- To evaluate the association between polypharmacy and adverse outcomes in type 2 diabetes patients in rural Montana.
- To inform strategies for improving medication adherence and reducing complications in underserved regions.
Main Methods:
- Utilized a large-scale clinical database (Big Sky Care Connect Database) of 591 type 2 diabetes patients.
- Stratified patients into non-polypharmic (1-4), polypharmic (5-9), and hyperpolypharmic (≥10) medication cohorts.
- Analyzed Major Adverse Cardiovascular Events (MACE) and Diabetes Complication Severity Index (DCSI) using regression models.
Main Results:
- Polypharmacy was significantly associated with male gender.
- Medication count and age were significant predictors of MACE.
- Neuropathy and nephropathy prevalence increased significantly with higher medication counts.
Conclusions:
- High prevalence of polypharmacy observed in rural Montana type 2 diabetes patients.
- Polypharmacy is a significant predictor of MACE and increases the risk of nephropathy.
- Highlights the need for medication review and coordinated management to mitigate adverse outcomes.
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