(045) Effect of COVID-19 restrictions on insulin consumption in Turkey: Results from Changes in Nationwide Drug Consumption During the Pandemic Study

Background: The introduction of restrictions amid the COVID-19 pandemic led to lifestyle changes and challenges in accessing healthcare services, potentially complicating the management of chronic disorders like diabetes mellitus. This might have affected the utilization of the medications crucial for managing such conditions, notably insulin.

Objectives: We aimed to assess the influence of the COVID-19 pandemic on insulin utilization.

Methods: We acquired nationwide outpatient medication sales data for 01.03.2018-31.12.2022 from IQVIA Turkey and the prescribing projection data for the corresponding timeframe. Insulin utilization was examined in this sub-analysis of a comprehensive study, which included antidiabetics among six main drug groups of interest. Average monthly consumption and cost of insulins, along with the quarterly levels of insulin prescribed across three distinct periods defined as “before restrictions” (BfR, 01.03.2018-31.03.2020), “during restrictions” (DuR, 01.04.2020-31.03.2022), and “after restrictions” (AfR, 01.04.2022-31.12.2022) were evaluated. We measured the utilization levels via “defined daily dose per 1000 inhabitants” (DID) metric.

Results: The mean monthly insulin consumption increased from 52.1±6.7 DID in BfR to 65.3±10.0 DID in DuR (p < 0.001), then reduced to 54.0±11.3 DID in AfR (p=0.006 vs. DuR). Short-acting insulins exhibited a similar pattern, rising from 23.7±2.9 DID in BfR to 30.0±4.7 DID in DuR (p < 0.001), before falling to 24.5±5.3 DID in AfR (p=0.003 vs. DuR). Long-acting insulins also escalated from 19.8±3.0 DID in BfR to 26.2±4.4 DID in DuR (p < 0.001), followed by a nonsignificant decline to 23.0±5.6 DID in AfR (p>0.05 vs. both previous periods). The mean quantity of prescribed insulins was 1.6±0.1 million units in BfR, diminished to 673.7±87.5 thousand units in DuR (p < 0.001), and subsequently increased to 1.2±0.3 million units in AfR, yet remained below initial levels (p=0.002 vs. BfR, p< 0.001 vs. DuR). The mean monthly cost for insulins was 27.0±3.7 million Euros (m€) in BfR, raised to 33.4±5.8 m€ in DuR (p < 0.001) and later reduced to 27.9±6.4 m€ in AfR (p=0.046 vs. DuR).

Conclusions: This study highlighted a surge in short- and long-acting insulin consumption during pandemic restrictions, which was later partially normalized. Considering the opposite trend in insulin prescribing, these conflicting results might be potentially attributed to an increase in need for pharmacotherapy to attain glycemic control, in addition to stockpiling of this crucial medication during the pandemic and subsequent consumption from these reserves.