A population-based analysis of insulin management patterns in a province of southern Spain (2014-2018)

Aim: The aim of this study was to analyze the patterns of insulin consumption between 2014 and 2018 in Cádiz. Methods: This study was a cross-sectional retrospective study. All people that used any insulin were included in the study. The Cadiz Diabetes Database includes data on yearly anti-diabetic prescriptions and hemoglobin A1c (HbA1c) levels. Results: The prevalence of insulin-users was 2.15%. More prevalent in women and increased with age (0.18% in the 0-15-year-old group to 8.53% in the > 75-year-old group); insulin’ users represent 28.8% of the total population with diabetes mellitus treatments. Seventy percent of insulin-treated patients (ITP) were over 60 years old. Long-acting insulin was consumed by 79% of users, representing 55% of the total insulin types consumed. Glargine was the most consumed (4,654,000 defined daily dose and valuing > 7.000.000€ in 2018). In > 75-year-old group, 50% were treated with long-acting and fast-acting insulin combinations. Annual HbA1c was determined for two out of three ITP and 37% of these had Hb1Ac < 7% (53 mmol/mol). Conclusions: The Cadiz population presents a high consumption of insulin. Insulin prescription patterns have changed during the study. Long-acting insulins, especially Glargine (alone or in combination), are the most widely used types of insulin. In the group of elderly patients, the patterns found are not in line with the current recommendations. ITP in Cadiz has a poor glycemic (median HbA1c 7.84%) control and a low amount of Hb1Ac determinations.