(C-090) Trends in insulin utilization and SARIMA forecasting: A time-series analysis in Greece (2016–2023) using IQVIA dataset

Background: Insulin therapy is essential for diabetes management, with a shift from human insulins to long-acting basal and rapid-acting analogs. Understanding consumption trends and forecasting future utilization can inform clinical and policy decisions

Objectives: This study analyzes insulin utilization trends in Greece from 2016 to 2023, evaluates differences across formulations, and predicts future usage using Seasonal AutoRegressive Integrated Moving Average (SARIMA) models.

Methods: A retrospective time-series study was conducted using IQVIA consumption data, measured in defined daily doses (DDD) per 1,000 inhabitants per day. Trends were assessed using Kendall’s Tau correlation, and differences in utilization were examined via one-way ANOVA. SARIMA models were applied to forecast usage, with Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) guiding model selection.

Results: Insulin Glargine (7.59 DDD, SD = 0.51) and Insulin Degludec (3.66 DDD, SD = 1.20) had the highest utilization among long-acting insulins, while Insulin Aspart (2.97 DDD, SD = 0.28) and Insulin Lispro (2.22 DDD, SD = 0.16) were the most used rapid-acting insulins. Intermediate-acting insulins, including Insulin Human Isophane (0.67 DDD, SD = 0.10) and Insulin Human (0.47 DDD, SD = 0.10), showed significant declines, with Insulin Detemir having the lowest utilization (0.45 DDD, SD = 0.11). Time-series analysis confirmed increasing trends for Glargine (τ = 0.86, p < 0.0001), Degludec (τ = 0.83, p < 0.0001), and Aspart (τ = 0.78, p < 0.0001), while Human (τ = -0.92, p < 0.0001) and Human Isophane (τ = -0.95, p < 0.0001) declined. ANOVA results indicated significant utilization differences among insulin types (F = 2248.42, p < 0.0001). SARIMA models projected continued growth in Degludec and Glargine through 2025, while Aspart and Lispro are expected to stabilize. Intermediate-acting insulins, including Human Isophane and Human , are forecasted to decline further. Detemir is projected to approach minimal utilization. Model selection was based on AIC and BIC, with well-fitted models for Human (-311.37, -300.20), Lispro (-99.29, -88.12), Aspart (-65.95, -54.78), Glulisine (-186.29, -175.12), and Human Isophane (-274.38, -263.21).

Conclusions: Insulin prescribing in Greece has shifted toward long-acting basal and rapid-acting analogs, while traditional human insulins continue to decline. SARIMA models predict sustained increases in Glargine and Degludec utilization, while older formulations, including Human and Detemir, are expected to decline further. These findings highlight the need for adaptive prescribing strategies that align with evolving clinical guidelines.