The impact of drug interactions on biochemical parameters in Libyan patients with diabetes and hyperlipidemia

Abstract :

Polypharmacy, defined as the concurrent use of five or more medications, is highly prevalent among older adults because of the increasing burden of chronic diseases such as diabetes mellitus and hyperlipidemia. In these patients, polypharmacy may complicate disease management, mask clinical manifestations, alter biochemical parameters, and reduce medication adherence, ultimately compromising therapeutic outcomes. Drug-related problems, defined as events or circumstances involving drug therapy that interfere with desired health outcomes, are common in this population because of multiple comorbidities and inappropriate prescribing. This study evaluated the effects of diabetes mellitus, hyperlipidemia, and their coexistence, as well as potential drug-drug interactions, on selected biochemical parameters. Libyan patients were categorized into three groups: Diabetes mellitus, hyperlipidemia, and mixed (patients with both conditions). Fasting blood glucose and glycated hemoglobin levels were significantly higher in the diabetes group than in the hyperlipidemia and mixed groups. Lipid profile parameters were significantly elevated in the hyperlipidemia group compared with the other groups. Liver function tests and serum electrolyte levels remained within normal reference ranges, with no significant differences among the study groups. Within the mixed group, patients receiving insulin plus atorvastatin exhibited a modest but significant increase in total cholesterol and high-density lipoprotein cholesterol compared with those receiving metformin plus atorvastatin. In contrast, triglyceride and low-density lipoprotein cholesterol levels showed no significant differences. The present findings demonstrate distinct biochemical profiles among patients with diabetes mellitus, hyperlipidemia, and their coexistence, while suggesting that the evaluated drug combinations exert limited effects on lipid metabolism.

References

1. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatrics. 2017; 17: 2-30. doi:10.1186/s12877-017-0621-2
2. Maher RL Jr, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in the elderly. Expert Opinion on Drug Safety. 2014; 13(1): 57-65. doi: 10. 1517/14740338.2013.827660
3. Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: Basic principles and practical applications. British Journal of Clinical Pharmacology. 2004; 57(1): 6-14. doi: 10.1046/j.1365-2125.2003.02007.x
4. Hilmer SN, McLachlan AJ, Le Couteur DG. Clinical pharmacology in the geriatric patient. Fundamental and Clinical Pharmacology. 2007; 21(3): 217-230. doi: 10.1111/j.1472-8206.2007.00473.x
5. Alssageer MA, Mohammed ES, Abd-Alsalm SA. Prevalence of comorbidity and polypharmacy among hospitalized elderly patients. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2022; 2(1): 53-61. doi: 10.5281/zenodo.6399521
6. Alssageer MA, Saad MM, Mosbah OM. Prevalence of comorbidities, polypharmacy and drug-related problems among hospitalized patients withchronic kidney disease. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2023; 3(1): 51-63. doi: 10.5281/zenodo.7771698
7. American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of care in diabetes-2025. Diabetes Care. 2025; 48(Suppl 1): S27-S49. doi: 10.2337/dc25-S002
8. Wastesson JW, Morin L, Tan ECK, Johnell K. An update on the clinical consequences of polypharmacy in older adults: A narrative review. Expert Opinion on Drug Safety. 2018; 17(12): 1185-1196. doi: 10.1080/14740338. 2018.1546841
9. Ahmed AA, Alapid AA, Ahmed ZM, Moudah NNJ, Salim HM. Correlational study of vitamin D deficiency and dyslipidemia among adult Libyan population. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2025; 5(2): 96-103. doi: 10.5281/zenodo.15381077
10. Gamag EA, Albakoush AS, Rashade MJ, Kassab BA, Albasha SA. Glycosylated hemoglobin in type 2 diabetic patients as a biomarker for predicting dyslipidemia. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2024; 4(4): 1-5. doi: 10.5281/zenodo.13993737
11. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. American Journal of Hospital Pharmacy. 1990; 47(3): 533-543. doi: 10.1093/ajhp/47.3.533
12. O'Connor MN, Gallagher P, O'Mahony D. Inappropriate prescribing: Criteria, detection and prevention. Drugs and Aging. 2012; 29(6): 437-452. doi: 10.2165/11632610-000000000-00000
13. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: The patient-centered approach to medication management services. 3rd Ed. New York: McGraw-Hill Medical; 2012. ISBN 978-0-07-175638-9.
14. Elmiladi SA, Elgdhafi EO. Prevalence of cardiovascular risk factors in Libyan patients with type 2 diabetes mellitus.Mediterr J Pharm Pharm Sci. 2023; 3(2): 27-33. doi: 10.5281/zenodo.7877416
15. Alfoghi AMO, Keshlaf SA, Elmiladi SAA. Clinical profile of Libyan patients admitted with diabetic ketoacidosis. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2024; 4(2): 15-22. doi: 10.5281/zenodo.11154992
16. Gallagher DA, Parkkinen L, O'Sullivan SS, Spratt A, Shah A, Davey C, et al. Testing an aetiological model of visual hallucinations in Parkinson's disease. Brain. 2011; 134(11): 3299-3309. doi: 10.1093/brain/awr225
17. O'Mahony D, O'Sullivan D, Byrne S, O'Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: Version 2. Age and Ageing. 2015; 44(2): 213-218. doi: 10.1093/ageing/afu145
18. Masoud AA, Sherif FM. Assessment of prescribing patterns and indicators in the Libyan private clinical settings. Mediterranean Journal of Medicine and Medical Sciences. 2026; 2(1): 66-74. doi: 10.5281/zenodo.19359509
19. Elreyani NE, Frewan AI, Abushawashi AM. Medication adherence and clinical outcomes among Libyan patients with chronic diseases:A comparative study of public and private healthcare sectors. Mediterranean Journal of Medical Research. 2025; 2(3): 141-147. doi:10.5281/zenodo.17127614
20. Long DE, Kosmac K, Dungan CM, Bamman MM, Peterson CA, Kern PA. Potential Benefits of Combined Statin and Metformin Therapy on Resistance Training Response in Older Individuals. Front Physiol. 2022 Apr 14;13:872745. doi: 10.3389/fphys.2022.872745
21. Ooba N, Tanaka S, Yasukawa Y, Yoshino N, Hayashi H, Hidaka S, et al. Effect of high-potency statins on HbA1c in patients with or without diabetes mellitus. Journal of Pharmaceutical Health Care and Sciences. 2016; 2: 8. doi: 10.1186/s40780-016-0040-0
22. Erqou S, Lee CC, Adler AI. Statins and glycaemic control in individuals with diabetes: a systematic review and meta-analysis. Diabetologia. 2014; 57(12): 2444-2452. doi: 10.1007/s00125-014-3374-x
23. Alvarez-Jimenez L, Morales-Palomo F, Moreno-Cabañas A, Ortega JF, Mora-Rodríguez R. Effects of statin therapy on glycemic control and insulin resistance: A systematic review and meta-analysis. European Journal of Pharmacology. 2023; 947: 175672. doi: 10.1016/j.ejphar.2023.175672
24. Yang G, Schooling CM. Statins, type 2 diabetes, and body mass index: a univariable and multivariable Mendelian randomization study. The Journal of Clinical Endocrinology and Metabolism. 2023; 108(2): 385-396. doi: 10.1210/clinem/dgac562

Citation :

Abrika OSS, et al. The impact of drug interactions on biochemical parameters in Libyan patients with diabetes and hyperlipidemia. Mediterr J Pharm Pharm Sci. 2026; 6(3): 33-39. [Article number: 259]. https://doi.org/10.5281/zenodo.21833611