COVID-19 led to overall drop in adult insulin prescribing, study shows – Community News
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COVID-19 led to overall drop in adult insulin prescribing, study shows

While the authors say their findings shed light on potential insulin supply disruptions during COVID-19, they note that they were unable to adapt to those with diabetes who died.

Insulin prescribing patterns peaked and troughed in the weeks before and after the United States shut down in early 2020 due to the COVID-19 pandemic, suggesting that at least some of the 7 million people taking the hormone to treat diabetes may be not obtain it.

Fluctuations in the number of insulins prescribed were reported last week in a research letter in JAMA network opened, with the insights gained from IQVIA claims data.

The analysis, led by Ismaeel Yunusa, PharmD, PhD, Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, found signs that some patients had stored insulin in the weeks before a national emergency was declared on March 16, 2020 , marking the official start of the pandemic in the United States. This was followed by a brief, sharp drop in insulin prescribing and then a new, lower baseline of adult prescriptions. There were also new recipes.

Insulin is used to treat both type 1 (T1D) and type 2 diabetes (T2D). Patients with T1D must rely on insulin for survival, while patients with more severe T2D may use insulin to maintain glycemic control. However, patients with T2D can be treated with a variety of other therapies, including both oral and injectable drugs.

An important limitation of the study is the fact that the available data did not allow researchers to adjust for mortality. People with diabetes were known to be at higher risk of serious illness and death from COVID-19; in July 2021, the American Diabetes Association reported that 40% of those who died from COVID-19 had diabetes. So part of the drop in prescribing may be due to patient death.

After an initial decline, the baseline for pediatric insulin prescriptions returned to pre-pandemic levels, the authors found. They speculated that this is due to the fact that most pediatric patients use insulin to treat T1D. In general, new regulations also declined.

“Reduced access to medical care and supply disruptions related to the pandemic may have reduced access to insulin, potentially adversely affecting diabetes control,” the authors wrote.

Conversely, they wrote that as more people signed up for Medicaid due to job losses, expanded access to telemedicine may have offset the initial disruptions, at least for some patients.

The study of prescription data assessed insulin prescribing as of January 2019 to establish a baseline. A total of 285,343 people were included in the analysis; the group had a mean age of 56.6 years and 51.9% were female. Periods with important holidays were excluded from the analysis.

The baseline count for all existing prescriptions was 17,037.5 per week before the pandemic (range of 16,728.7-17,346.3). In the months before the pandemic, prescribing steadily increased by an average of 11.0 prescriptions per week (range 2.0-19.3). In the week immediately following the start of the pandemic, prescription drugs dropped by 395.6 (-933.5 to 142.4); including a 139.2 decrease in pediatric prescriptions.

However, pediatric prescribing recovered and weekly counts for pediatric users fell by just 1.2 prescriptions per week. In general, insulin prescriptions decrease by 55.3 per week among existing patients; including 54.2 per week in adults. Prescriptions for new insulin users decrease by 14.0 prescriptions per week.

Data presented with the research letter shows that insulin prescribing for both adult and pediatric users peaked just before the March 16 emergency. Adult prescriptions reached about 17,500 per week, while the pediatric peak reached more than 1150 per week, and then prescriptions dropped to 1018 per week.

“This study found a significant drop in the average number of weekly insulin prescriptions during the COVID-19 pandemic. Decreased contact with prescribing clinicians during the pandemic, rationing, past supplies or loss of insurance could explain the decline,” the authors wrote.

Despite the limitation on being able to adjust for mortality, they said: “We believe these findings contribute to a better understanding of the association of the pandemic with insulin treatment for diabetes. Future studies should examine whether the pandemic was associated with adverse health outcomes that associated with suboptimal insulin treatment.”

Reference

Yunusa I, Love BL, Cai C. Trends in insulin prescribing for patients with diabetes during the US COVID-19 pandemic. JAMA Netw Open. Published on November 3, 2021. doi:10.1001/jamanetworkopen.2021.32607