Diabetes patients risk taking more drugs as treatment side effects trigger new prescriptions

Diabetes patients risk taking more drugs as treatment side effects trigger new prescriptions

A study involving more than 387,000 participants warns that side effects from diabetes drugs may be mistaken for new illnesses, leading to additional prescriptions and increasing patients' medication burden.

People living with type 2 diabetes may end up taking additional medications to treat side effects caused by their initial treatment, increasing their medication burden and potentially exposing them to further adverse reactions, a new study has found.

Published in BMC Medicine, the study analysed two large healthcare databases covering more than 387,000 participants to investigate whether patients were prescribed additional drugs to manage side effects associated with their existing medication.

Researchers identified seven potential prescribing cascades among 12 medication combinations examined.

A prescribing cascade occurs when a side effect caused by one medication is mistaken for a new medical condition, prompting a healthcare provider to prescribe another drug to treat the resulting symptoms.

This can leave patients taking multiple medications, even when some of the symptoms they experience may be linked to their original treatment rather than a separate health condition.

One of the medication groups identified in the study was sodium-glucose cotransporter-2 (SGLT2) inhibitors, commonly prescribed to manage blood sugar levels in people with type 2 diabetes.

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These drugs work by preventing the kidneys from reabsorbing glucose into the bloodstream, allowing excess sugar to be eliminated through urine.

Although they help lower blood sugar, the increased glucose in urine can create conditions that encourage genital yeast infections. Patients may also experience frequent urination and dizziness.

Researchers found that people taking SGLT2 inhibitors were more likely to receive antibiotics for urinary tract infections, antifungal medications for fungal infections and drugs used to manage overactive bladder.

Another group linked to potential prescribing cascades was thiazolidinediones, which help the body use insulin more effectively.

However, these medications can cause fluid retention, leading to swelling, particularly around the legs and ankles. The study found that patients taking them were more likely to be prescribed loop diuretics, commonly known as water pills, which help the body eliminate excess salt and water through urine.

The researchers also identified potential prescribing cascades involving other medications commonly used by people with diabetes to manage related health conditions.

These included statins, which lower cholesterol and help reduce cardiovascular risks, and calcium channel blockers, commonly prescribed to control high blood pressure.

The analysis found that statin use was sometimes followed by prescriptions for overactive bladder medications and hypnotics, which are used to manage sleep disturbances.

Calcium channel blockers were also associated with subsequent prescriptions for loop diuretics, potentially to address swelling in the lower limbs.

According to the researchers, prescribing cascades may contribute to polypharmacy, a situation in which patients take multiple medications, increasing the complexity of treatment and the risk of drug interactions.

“Prescribing cascades may contribute to polypharmacy in people with type 2 diabetes,” according to the researchers.

The researchers emphasised that not every additional prescription was necessarily unnecessary. However, they said healthcare providers should consider whether newly reported symptoms could be linked to existing medication before introducing another drug.

Recognising adverse drug reactions as a possible cause of new symptoms could help identify opportunities to stop or modify the medication responsible, the researchers noted.

This approach could reduce unnecessary prescriptions and the burden of managing multiple medications, particularly among older adults who may already be receiving treatment for several chronic conditions.

The findings highlight the importance of reviewing patients' medication histories and considering potential side effects whenever new symptoms emerge, rather than automatically introducing another prescription.

Identifying these patterns could help healthcare providers make more informed treatment decisions and reduce the number of medicines patients need to manage their conditions.

In Kenya, about 813,300 adults were living with diabetes in 2024, the majority of them with type 2, according to the International Diabetes Federation (IDF) 2025 Diabetes Atlas. The country is part of a growing regional burden, with approximately 24.6 million people living with diabetes across Africa.

Type 2 diabetes accounts for approximately 90 per cent of all diabetes cases worldwide. Globally, an estimated 589 million adults were living with diabetes in 2024, including about 530 million with type 2. The number is projected to rise to 853 million by 2050.

The findings raise concerns about the growing medication burden among people managing diabetes, particularly those who also require treatment for high blood pressure, high cholesterol and other chronic conditions. In Kenya, where hundreds of thousands of adults are living with diabetes, regular medication reviews could help identify side effects before they lead to additional prescriptions.

The World Health Organization (WHO) recommends preventing or delaying type 2 diabetes through healthy eating, maintaining a healthy weight, avoiding tobacco and engaging in at least 150 minutes of moderate physical activity each week. Regular blood sugar screening is also important, particularly for people with a family history of diabetes, those who are overweight and people with high blood pressure.

For Kenyans already receiving treatment, the study highlights the importance of reporting new symptoms and having healthcare providers assess whether they could be side effects of existing medication. Identifying these reactions early may allow doctors to adjust or change the original treatment rather than automatically prescribing additional drugs.

The researchers caution that not every additional prescription is unnecessary. Patients should not stop or change their medication without consulting their healthcare providers.