Pharmacy and Healthcare:Diabetes expert conference takeaways
Topics of our conference included of the incidence of diabetes, the growth drivers of insulin and oral anti-diabetic drugs(OAD), the treatment on diabetes complications and the comparison on two incretins that recently included in NRDL (DPP-4 inhibitors and GLP-1 agonists).
1) According to JAMA, the incidence of diabetes among adults above 20 in China was 10.9% (2013: 11.6%). The treatment and control rates of diabetes were 32% (flat with the previous survey) and 49% in China (rebounded from 2010, showing the efficacy in diabetes treatment).
2) Demand drivers in insulin and OAD: The former was driven by demand in lower-tiers cities/rural areas, owing to the low treatment rate, increasing penetration, lack of new OADs, etc, while the later was driven by mid/large cities, as new patients that emerge from medical examinations are mainly treated by OADs. Endocrinology doctors from Huashan Hospital have been training lower-tier cities/rural doctors and conducted lifestyle intervention in communities. Among MNCs, Lilly’s Humulin had better penetration in lower tier hospitals while Novo Nordisk’s Novolin has lower penetration. Market share of Chinese insulin players was higher in rural markets. Pressure from the drug sales ratio cap is still high in endocrinology department.
3) Medications for diabetes complications: the highest occurring complications are atherosclerosis (81%), hypertension (64%), obesity/overweight (62%), non-alcoholic fatty liver (57%), diabetic nephropathy (33%). Among these diabetic nephropathy will be the major cause of China’s ESRD (the end stage renal disease) in future - diabetic nephropathy accounted for over 45% of new ESRD cases in developed countries. Given China’s c.30mn diabetic nephropathy patients, he estimated that ESRD patients will reach 10mn in 10-15 years, compared to 200k dialysis patients now. All these imply a huge market potential in drugs for the prevention/treatment of diabetic nephropathy. Medications combined with metformin treatment for atherosclerosis have achieved very good effects, and DPP-4 was also found to have CCV benefits. The drugs for diabetic nephropahy are mainly ACEI, IL-1, TCM (such as Rhein and Berberine).
4) DPP-4 inhibitors and GLP-1: GLP-1s have better efficacy than DPP-4 - apart from lowering blood glucose levels, they can reduce cardiovascular incidents, but their prices are rather high. The long-effect GLP-1 (Bydureon) has more potential than Byetta and Victoza (once/twice a day injections). DPP-4 inhibitors have been included in NRDL recently mainly for affordable prices and ease for use (orally, one tablet per day), which should boost sales.