Assessment of Cost and Diabetes Management Due to Polypharmacy in Iran Based on Haemoglobin A1c Levels, A Cross Sectional National Study

Background Patients with diabetes often receive multiple drug regimens termed ‘polypharmacy’. Since polypharmacy imposes excessive cost, we evaluated the prescriptions of patients with diabetes regarding polypharmacy, and its association with HbA1c levels and cost. Method 102 million prescriptions of Iranian health insurance data in 2015 and 2016 were overlapped with STEPS Iran 2016 survey database. Then, 2075 Metabolic syndrome patients were selected. Among the patients who consumed anti diabetes medications; individual and sociodemographic factors, and polypharmacy were assessed and association between these factors and HbA1c levels were quantified using logistic regression. Each patient’s prescription costs in 2015 and 2016 and its association with individual and sociodemographic factors as well as polypharmacy was assessed using linear regression. Results Out of 2075 metabolic syndrome patients, 205 patients had diabetes according to their fasting blood glucose in 2015 and 2016. HbA1c was significantly more controlled (≤7%) in urban areas. No significant association existed between polypharmacy and HbA1c levels. Medication cost was significantly higher in male patients, patients above 80 years, and patients with >12 years of education (p< 0.05). Area of living and wealth index had no significant association with cost. Conclusion Although diabetic patients with polypharmacy significantly pay more money for their prescriptions, no significant difference was observed between their HbA1c levels.