Demographic, medication, clinical, and laboratory data were collected using a modified case-report form. Potential drug-drug interactions, adverse drug reactions, medication adherence, and episodes of falls were identified and documented. The prevalence, type, mechanism, and consequences of potential drug-drug interactions were assessed using the Lexicomp database, categorizing interactions as severe, moderate, or minor. Pharmacists intervened to manage potential drug-drug interactions in collaboration with physicians, with assessments and management occurring from the first day following the identification of polypharmacy. Adverse drug reactions, particularly hypoglycaemia due to polypharmacy, were assessed by observing signs and symptoms, such as loss of consciousness, sweating, hunger, and anxiety. Various parameters, such as age distribution, gender, diabetes duration, number of drugs per prescription, therapeutic class of drugs, type of insulin used, dosage form, prescribing indicators, and laboratory data (including blood glucose levels during the first seven days), were used in the assessment. Blood glucose levels below 70 mg/dl were classified as hypoglycaemic. The causality and severity of adverse drug reactions were assessed using the Naranjo and modified Hartwig and Siegel scales, respectively. Medication adherence to polypharmacy was evaluated using the Morisky Medication Adherence Scale. Episodes of falls due to polypharmacy were documented over a one-month period through telephonic follow-up, with falls assessed by enquiring about the type of fall experienced by the patient or their relatives.

The Naranjo Scale was used to standardize the assessment of causality for all adverse drug reactions. The ADR Probability Scale consists of 10 questions that are answered as either yes, no, or do not know. Different point values (-1, 0, +1, or +2) were assigned to each answer. Total scores range from -4 to +13; the reaction is considered definite if the score is 9 or higher, probable if it is 5 to 8, possible if it is 1 to 4, and doubtful if it is 0 or less.

The term severity was used to describe the intensity of a medical event, as in grading mild, moderate, and severe. The severity assessment categorizes ADRs as mild, moderate, or severe based on the steps taken for the management of ADRs. Hartwig and Siegal categorized ADRs into seven levels according to their severity. Levels 1 and 2 fall under the mild category, levels 3 and 4 under the moderate category, and levels 5, 6, and 7 under the severe category.

The Morisky Medication Adherence Scale (MMAS-8) was used to assess patient adherence. The patients were asked eight questions to assess their medication use behaviour. Score is given as every correct answer is given ―0‖ and wrong answer as ―1‖. The scale categorizes adherence as high adherence (0), medium adherence (1-2) and low adherence (3-8) based on the scores.

Multiple analysis of variance (MANOVA) was used to analyze the variance, with two or more dependent variables which measured different aspects of some cohesive themes, including several different reductions in BP (for example. DAY0, DAY3 & DAY6).

The NIPALS Algorithm ("Nonlinear Iterative Partial Least Squares") was used for calculating the principal components of a data set which gives more numerically accurate results when compared with the singular value decomposition (SVD) of the covariance matrix, but is slower to calculate.

Descriptive analysis was conducted for demographic data. The correlation between blood glucose levels and falls was analyzed using a Multivariate Analysis of Variables (MANOVA). Various factors such as polypharmacy, age, gender, and other factors that might correlate with falls and adverse drug reactions (ADRs) were assessed using the statistical method of Nonlinear Iterative Partial Least Squares (NIPALS) at a significance level of P<0.000.

The patients were divided into groups depending on the number of years they had been suffering from diabetes. 34 patients were diagnosed with diabetes within the past 1-5 years. 44 patients were diagnosed with diabetes for 6-10 years. Sixteen individuals belonged to the group aged 11-15 years and five patients had diabetes for 16-20 years and one individual had diabetes for more than 20 years (Table 1 ).

The distribution of the study patients based on their social habits revealed that 33% of them were alcoholics and 34% were smokers (Table 1 ).

Polypharmacy was divided into prescriptions containing four, 5-7 drugs, to 8-10 drugs and more than ten drugs consumed by 10%, 33%, 45%, and 12%, respectively (Table 1 ).

The drugs utilized by the patients were categorized based on whether they were administered single or combination therapy. Among all patients, 59 (59%) were on monotherapy and 41 (41%) were on combination therapy; 38 patients were consuming two drugs and three drugs were consumed by three drugs (3%) (Table 1 ).

The study included 100 patients with various comorbid conditions, and 19% of them had diabetes alone. The most common combination was diabetes with hypertension (15%) and diabetes with COPD (13%). Other notable combinations included diabetes with peripheral neuropathy (10%), diabetes with hypertension and COPD (9%), and diabetes with gastroenteritis (4%). There were also instances of diabetes with hemiparesis, rheumatoid arthritis, benign prostatic hyperplasia, blood disorders, alcoholic liver disease, hyperlipidaemia with COPD, and hypertension with cerebrovascular accidents, each affecting 1% of the patients. Additionally, some patients had more complex conditions, such as diabetes with hypertension, ischaemic heart disease, and COPD (4%), diabetes with hypertension and ischaemic heart disease (2%), and diabetes with Alzheimer's disease and lower respiratory tract infection (2%). Other combinations, such as diabetes with asthma, polyarthralgia, lower respiratory tract infection, and urinary tract infection with anaemia and hypothyroidism, were present in smaller percentages (Table 2 ).

The level of medication adherence of study patients was assessed using the Morisky Adherence Scale for patients on polypharmacy before admission to the hospital. We found that 10 patients were not on polypharmacy before admission, 17 patients were found to be highly adherent, 41 were medium adherent, and 32 patients were low adherent (Table 2 ).

It was found that, there are 6 major drug interactions, 59 moderate drug interactions, 42 minor drug interactions. We identified 42 minor interactions which were found to be less significant. (Table 2 ).

ADRs were observed in 6% of study patients. The observed ADRs were metformin-induced hypoglycaemia in three patients (3%), metformin-induced diarrhea in1 patient (1%), and glimepiride-induced dyspepsia in two patients (2%) (Table 2 ).

Table 3

Adverse type	n=100	%
Metformin induced hypoglycaemia	3	3%
Metformin induced diarrhoea	1	1%
Glimepiride induced dyspepsia	2	2%
ADR probability of study subjects
Causality of ADR	n=100	%
Possible	2	33.33%
Probable	2	33.33%
Doubtful	2	33.33%
Severity of ADR
Severity of ADR	n=100	%
Severe	0	0%
Moderate	1	16.66%
Mild	5	83.33%

In present study, it was found that the probability of ADR was possible (2), probable (2), and doubtful (2). Among the observed ADRs, 33.33% were possible, 33.33% probable, and 33.33% doubtful (Table 3 ).

The severity of ADRs was assessed using the Modified Hartwig and Siegal scale. This study found out one moderate and five mild ADRs. 83.33 Of the ADRs, 83.33% were mild, and 16.66% were minor. No severe ADRs were observed (Table 3 ).