Diabetes Self-Management Blog

Roughly 75% of older Americans have multiple chronic conditions, and more than 20% of them are taking medicines that work at cross-purposes — improving one of their conditions while worsening another — according to new a new study in the journal PLoS One.

To determine the prevalence of this “therapeutic competition,” researchers from Connecticut and Oregon looked at 5,815 adults age 65 and older in the United States. Using Medicare claims and in-person interviews, the study authors identified 14 of the most common chronic conditions treated with at least one medicine, along with medication classes recommended to treat these conditions and used by at least 2% of the study participants.

Of the 27 drug classes used to treat the most common chronic conditions, 15 recommended for use in one condition can have negative effects on another. Competing conditions include high blood pressure and diabetes; coronary artery disease and diabetes; high blood pressure and osteoarthritis; high blood pressure and chronic obstructive pulmonary disease (COPD); and high blood pressure and depression. Among the study participants, 22.6% were taking at least one medicine known to adversely impact another of their conditions. For example, 16.2% of the study subjects with both hypertension and COPD were using a nonselective beta-blocker — a type of drug that can cause airway resistance, worsening COPD — to control their blood pressure.

“More than 9 million older adults in the US are being prescribed medications that may be causing them more harm than benefit,” said study coauthor Jonathan Lorgunpai.

Competition between medicines is not the only concern, according to the study. Using multiple drugs can also increase the prevalence of falls, delirium, dizziness, fatigue, and loss of appetite.

“Drugs tend to focus on one disease at a time, and most physicians treat patients the same way. As a result, right now we’re probably treating too many conditions with too many medications. There may be times it’s best to just focus on the most serious health problem, rather than use a drug to treat a different condition that could make the more serious health problem even worse,” noted study author David S. H. Lee, PharmD, PhD.

Further study and more awareness of the issue are needed, the researchers suggest. Many doctors are aware of these issues, but few guidelines exist informing health-care providers how to identify other options. It may be possible, the authors continued, to make better judgments about which health condition takes treatment priority or to identify options for treating both conditions that don’t conflict with one another.

For more information, read the article “One in five older Americans take medications that work against each other” or see the study in the journal PLoS ONE. And to learn about drugs that can worsen diabetes control, read this article by clinical pharmacologist Mark T. Marino.


  1. How about giving a list of medications that conflict?

    Posted by Ann |
  2. I am taking drugs for high-blood pressure, diabetes and cholesterol daily. H1c is controlled so is cholesterol, but having some trouble with blood-pressure. This information I’ve read has me concerned. I will read more of this when time permits. Thanks

    Posted by Darlene |
  3. Hi Ann,

    Thanks for your comment. A table showing all of the competing conditions noted in the study, along with the classes of medicine in question, can be found here.

    Diane Fennell
    Web Editor

    Posted by Diane Fennell |
  4. Have diabetes 2 everything is ok except high blood pressure. It seems to fluctuate every two or three hours, resulting in bad headaches.

    Posted by Claudia |
  5. It would be more helpful to provide a list of the actual medications that are contraindicated for the lay reader. Thanks.

    Posted by Margaret Griffin |
  6. Hi Ms. Griffin,

    Thanks for your comment. Here is the information I was able to pull together as it relates to diabetes:

    High blood pressure and diabetes:
    Alpha/beta-blockers (Coreg, Normodyne, Trandate)

    Diabetes and coronary artery disease:
    Alpha/beta-blocker (Coreg, Normodyne, Trandate)
    Sulfonylurea (Tolinase, Diabinese, Glucotrol, Gluctrol XL, Orinase Micronase, Glynase Prestab, Diabeta, Amaryl)
    Glitazone (Avandia, Actos)

    Diabetes and chronic obstructive pulmonary disease:
    Corticosteroid (Aristocort, Bubbli-Pred, Celestone, Cortone Acetate, Cotolone, Decadron, Deltasone, Dexamethasone Intensol, Entocort EC, Florinef Acetate, Medrol, Methylpred-DP, Prednicot, Prelone)

    Diabetes and heart failure:
    Alpha/beta blocker (Coreg, Normodyne, Trandate)
    Glitazone (Avandia, Actos)

    Diabetes and atrial fibrillation:
    Alpha/beta-blocker (Coreg, Normodyne, Trandate)

    Diabetes and benign prostatic hypertrophy:
    Alpha-adrenoreceptor antagonist (Cardura, Rapaflo, Minipress, Flomax, Uroxatral, Hytrin)

    Diabetes and depression:
    Tricyclic antidepressant (Anafranil, Elavil, Norpramin, Pamelor, Sinequan, Surmontil)

    Diabetes and osteoporosis:
    Glitazone (Avandia, Actos)

    However, please note that this is not a complete list: There are 17 other pairs of competing conditions included in the study that do not involve diabetes, but that may include another condition that is relevant to your situation. I would recommend having a look at the table here and seeing if you have any of the pairs of conditions listed in the left-hand column. If so, your best bet would be to print the table out and bring it to your next doctor’s appointment to discuss whether any of the medicines you’re taking for those conditions are competing with one another.

    As always, do not stop taking any of your medicines without first speaking to your health-care provider.

    I hope this is helpful.

    Diane Fennell
    Web Editor

    Posted by Diane Fennell |
  7. I take Metformin, Coreg and Lotrel.(Generic). My BS still is not good enough. Do these conflict with each other

    Posted by Don |
  8. Hi Don,

    Thanks for your comment. I’m afraid I’m not authorized to answer specific medical questions — your best bet would be to speak with your doctor or diabetes educator about whether any of your medicines may be working against each other and about approaches you can take to improve your blood glucose control.

    Thanks for your interest in Diabetes Self-Management!

    Diane Fennell
    Web Editor

    Posted by Diane Fennell |
  9. I’ve been diagnosed as type II diabetic. I’m taking exforge, lantus, crestor and zedia. I feel absolutely aweful; tired, achy joints, sinusitus, bleeding gums and frequency urination. Please give me your thoughts. And not to forget belly fat. Thank you.

    Posted by Adelaide Smith |
  10. I have Diabetes ,High Blood Pressure and High Cholesterol. No one in my family tolerates the statin medicines I also got muscle pain with Zetia and stopped taking it. My doctor insisted that I take Lipitor for high cholesterol in spite of what I told her. There was a class action suit which was won by the way, because it was causing high blood sugars and Diabetes in females who did not have a family history of this.She is not my doctor any longer.

    Posted by PatriciaPursel |
  11. Things get even more adventurous when you see an osteopathic doctor, a cardiologist, an endocrinologist, and of course, your useless primary doctor who does little else than tell you to go see the above specialists. The useless primary provider doesn’t even e-mail or fax the specialists (nor do they always inform her of their prescriptions) of your medications/dosages, etc. to them. This is MEDICINE IN AMERICA, as opposed to say, The Netherlands, where EVERYTHING is digital and all relevant parties know everything. See those half-dozen people working behind the glass up front. They’re not working on your medical care complexities; they’re working on insurance claims.

    Posted by Edgar A. Koshatka |

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