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Disease Introduction
Diabetes is a chronic metabolic disorder related to insufficient insulin production by the pancreas or ineffective use of the insulin produced. Insulin enables glucose uptake into cells from the blood and use it for energy. Failure to produce insulin or of insulin to act properly, or both, leads to raised glucose levels in the blood (hyperglycaemia). This is associated with long-term damage to the body and comorbidity of various organs and tissues (renal failure withdialysis and transplantation, retinopathy and blindness, ulcersand amputation, etc.). Type 2 diabetes accounts for asmany as 90–95% of diagnosed diabetes cases globally and typically develops in middle-aged adults. Type 2 diabetescan remain undetected for many years and the diagnosis is often made from associated complications or incidentally through abnormal blood or urine glucose tests.
An estimated 285 million people, corresponding to 6.4% ofthe world’s adult population, lived with diabetes in 2010.The number is expected to grow to 438 million by 2030, corresponding to 7.8%. The prevalence of diabetes has reached epidemic proportions. The WHO predicts that developing countries will bear the majority of the burden of this epidemic in the 21st century. Currently, more than 70% of people with diabetes live in low- and middle income countries.
Diabetes costs – a burden for society
Diabetes imposes a large economic burden on the individual, national healthcare systems and economies. Healthc are expenditures on diabetes are expected to account for almost 12% of the total healthcare expenditure in the worldin 2010, i.e. approximately 418 billion USD. This number will probably increase to around 561 billion USD in 2030. Presented at an individual level it means that in 2010 as much as 878 USD per person globally was spent on diabetes.
Besides high healthcare costs, diabetes also imposes large economic burdens with respect to lost productivity and economic growth. The largest economic burden is the monetary value associated with disability and loss of life as a result of the disease and its associated complications. Unless properly addressed, the burden from diabetes and other non-communicable diseases will inevitably continue to increase. Furthermore, WHO predicts that diabetes – related deaths will double between 2005 and 2030.
Current diagnostics and treatments
Diabetes is diagnosed using a fasting plasma or serumglucose (FPG) test that measures blood glucose in a fasting person. Diabetes can also be diagnosed using an oral glucosetolerance test (OGTT) that measures blood glucose in a fasting person 2 hours after intake of a glucose-containing beverage. In addition, a random plasma glucose test (casual plasma glucose test) can measure blood glucosein a person that is not fasting. This latter test, along with considerations of symptoms, is used to diagnose diabetes but it cannot discover pre-diabetes. Test results should be confirmed with a second test on a separate day.
As much as 80% of type 2 diabetes is preventable by lifestyle changes such as improved diet, weight reduction and increased physical activity. Without effective prevention and control programmes, as well as early diagnosis, the incidence of diabetes is likely to continue to rise globally.
Along with lifestyle changes, oral anti diabetic (OAD) drug products are usually the first choice of therapy in newly diagnosed type 2 diabetes patients. Insulin therapy is vital for the survival of people with type 1 diabetes and is often required in later stages of type 2 diabetes. Even though insulinis on WHOs list of essential medicines, it is still unavailablein sufficient quantities in many parts of the developing world.
Latest and future development
Diabetes is strongly tied to altered trends in demographics and life style such as obesity and physical inactivity, and grows in its impact on healthcare. Therefore, the need for effective diagnostic products and improved therapy is imperativein the future management of diabetes.
There is growth for all product types, i.e. glucose meters, lancets, test strips, continuous blood glucose meters, insulin, insulin pumps, insulin sensors, syringes and other insulin delivery devices, and oral anti-diabetic drugs.
The business opportunity within diabetes is growing withthe continuously increasing number of people with diabetes (especially type 2 diabetes). According to forecasts, the global diabetes market is expected to increase from 56 million patients on treatment in 2010 to 82 million in 2019. Among the pharmacologically treated people with diabetes, 70% currently take OADs. This number is expectedto decline to about 63% in 2019 as the GLP-1 and insulin products are expanding rapidly. The worldwide diabetes market value is predicted to grow rapidly with a projected increase from USD 20 billion in 2010 to USD 36 billion in 2019.
