Diabetes is one of the most serious health problems in the modern world. Currently about 537 million1 adults live with diabetes worldwide and this number is rising significantly lly each year. It is expected to reach 643 million patients by 2030 and 783 million by 2045. Rising prevalence of diabetes results in placing this condition in the top 10 contributors to DALYS2 and causes 6.7 million deaths annually3. As for now, there is no drug that can permanently cure diabetes. Therefore, treatment is based on the management of the disease with the support of medications helping control the sugar levels. This contributes to better quality of patient life and limiting outcomes from the disease.
Diabetes as a chronic disease
Diabetes is a chronic disease connected with sugar metabolism. It is characterized by elevated levels of blood sugar caused by poor functions of pancreas and insulin production. There are two main types of diabetes: type 1 diabetes (T1D) and type 2 diabetes (T2D). T1D is a condition where pancreas does not produce insulin at all, or not enough for efficient sugar management. The majority of T1D cases are diagnosed early in life and the risk factor is mainly genetic. Treatment for patients with type 1 diabetes is based on insulin intake and in some cases additionally other oral drugs.
Type 2 diabetes is the most common type and accounts for about 90% of diagnosis. In case of T2D, pancreas does produce insulin, but it cannot work effectively, or there is not enough of it. Unlike T1D, type 2 diabetes is developed over time and is mostly diagnosed with adults. There are various risk factors leading to T2D, most of them connected with lifestyle. Besides stress, sedentary lifestyle, poor dieting habits and mental health issues, obesity is identified as the main cause of type 2 diabetes.
Is there a type 3 diabetes?
“Type 3 diabetes” is a term sometimes used to describe Alzheimer’s disease. Although it’s not officially recognized as a distinct form of diabetes, it shares similarities with other types. Researchers propose that insulin dysregulation in the brain contributes to dementia. However, controversy surrounds this theory, as major health organizations do not classify Alzheimer’s as a type of diabetes. Some studies show that blood sugar management might help prevent dementia, but it is not well-established practice just yet, as further research is needed to support this theory. Nevertheless, it is worth to pay extra attention to type 3 diabetes theory development, as it may effect in significant expansion of diabetes medicine market.
Global burden of diabetes
Regardless of diabetes possible impact on brain functioning, it is also linked more directly with many other health issues. It is well-established that diabetes is a leading cause of blindness, it may also lead to kidney disease, end-stage renal disease, lower limb amputation and cardiovascular conditions. Therefore the global burden of diabetes is a problem addressed by various organizations and authorities. Despite significant investments in clinical care, research and public health interventions, there appears to be no sign of slowing down the diabetes prevalence growth. Therefore the effective management of diabetes and accessible pharmacotherapies are crucial for patients’ well-being all around the world.
Effective management of diabetes and accessible pharmacotherapies
Treatment for T2D, besides lifestyle changes and weight loss, is most commonly based on oral medications. These include various groups of possible choices:
- Metformin – the first-line drug for T2D treatment. Metformin may be used in monotherapy and in combination with other molecules. The dosage varies between 500mg – 3 000mg daily.
- Sulfonylureas – so-called old generation of drugs, they lose their importance in favor of more modern options with less side effects, like flozins or gliptins.
- Sodium-glucose co-transporters type 2 inhibitors (SGLT-2 or flozins) – new-generation drugs, they increase the excretion of glucose in the urine, thereby lowering blood sugar levels. Additionally, they contribute to weight loss and have a beneficial effect on the circulatory system. Flozins include molecules like dapagliflozin and empagliflozin, which are the most dynamically developing drugs for T2D management4. Standard dosage for dapagliflozin is 5-10mg/daily, for empagliflozin 10-25mg/daily.
- Inhibitors of dipeptidyl peptidase 4 (DPP-4 inhibitors or gliptins) – novel oral glucose-lowering agents, which may be used as monotherapy or in combination with other antidiabetic compounds. DPP-4 inhibitors work by blocking the action of DPP-4, an enzyme that destroys the hormone, incretin, helping regulate the glucose level. Gliptins, like linagliptin or sitagliptin are the most mature new-generation drugs commonly used in T2D treatment. Standard dosage for linagliptin is 5mg/daily, for sitagliptin 100mg/daily.
GLP-1 influence on the diabetes market
Also worth mentioning is additional group of medicines known as GLP-1 (glucagon-like peptide 1). Initially, drugs from this group were indicated for type 2 diabetes treatment, but recent launches for weight loss shifted the paradigm of the GLP-1. Although, GLP-1 may still be considered as T2D medications, the real-world evidence (RWE) and medical practice along with further market analysis, suggest that GLP-1 unprecedentedly contribute to dynamic development of obesity treatment segment, rather than diabetes course.
As mentioned above, obesity is a leading cause of type 2 diabetes and proper weight management in long perspective surely will have an impact on diabetes prevalence and the market. Nevertheless, current predictions are suggesting, that therapeutic area for obesity treatment is about to expand to become one of the most valuable categories, right next to oncology, diabetes, immunology, anti-thrombotics, and respiratory therapeutic areas. Cannibalization of the diabetes drug space is unlikely, considering that RWEs show that patients taking GLP-1 drugs often have no prior history of diabetes treatment, suggesting market expansion rather than patients migration at the moment. For the foreseeable future, the only thing we can expect is a possible slowdown in the growth of diabetes medications at best, considering the GLP-1 therapies are extremely costly for patients and reimbursement systems catch-up is, at the moment, unknown. Keeping in mind, such a rapid developments of GLP-1 is unprecedented and it is very hard to estimate future outcomes of this phenomenon. All considered, generics development, in fact, may have bigger impact on diabetes market dynamics than GLP-1 hype, especially in countries with smaller economies than the US.
Most promising therapy
The market data supports the statement that the SGLT-2 (flozins) and DPP-4 (gliptins) are currently most promising therapy choices for patients suffering with diabetes. Medications like dapagliflozin, empagliflozin or sitagliptin and linagliptin constitute effective and patient-friendly therapy. These treatment choices respond to the continuous trend for accessible pharmacotherapy, which is provided by oral form and easy dosage, as well as relatively good cost-efficiency. These features ensure easy management for continuous, uninterrupted therapy, especially after generics expansion on regulated markets. New-generation drugs also provide safety and better side effect profiles which are crucial for patients well-being. Additionally, multiple benefits from using SGLT-2 and DPP-4, like kidney or cardiovascular benefits, are working in favor of patients with comorbidities.
Diabetes as the 2nd most valuable therapeutic area
The global burden of diabetes is reflected in market trends. Diabetes is the 2nd most valuable therapeutic area globally accounting for 171 bn USD in 2023 , with continuous growth potential. Main drivers for this therapeutic area, beside GLP-1, are dapagliflozin and empagliflozin. The dapagliflozin market in 2023 was worth over 13bn USD with a year-to-year growth rate at the level of 39%. Major markets for dapagliflozin are US and Europe, accounting for 35% volume market share, even before generics expansion. It is expected that the value of market will grow in double digits until the generics global entry.
Empagliflozin global market is currently worth 21,5bn USD, with a growth rate of 32% between 2022 and 2023. US itself accounts for almost 80% value market share, and 24% in volume. The biggest market is Europe with a 30% volume market share, but one of the most dynamic markets is currently Japan noting a growth rate at the level of 31% between 2022 and 2023.
Great potential therapeutic area
The diabetes therapy market holds significant potential, with advancements in patient-friendly treatments that support continuous care, highlighting the ever-increasing importance of diabetes management in global healthcare. Investing in this therapeutic category is becoming increasingly attractive due to the substantial demand and the ongoing development of innovative care approaches. Also, putting innovations aside, cost-effective therapies are essential, as they provide sustainable options for healthcare systems and patients alike. The growth of generic medications plays a crucial role in this sector, offering affordable alternatives without compromising on quality, ensuring that effective diabetes management is accessible to a wider population. This dual focus on innovation and affordability is key to addressing the global challenge of diabetes.
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1IDF Diabetes Atlas
2DALY indicator – an indicator used to determine the health status of a given society. It expresses the total years of life lost due to premature death or loss of health due to injury or disease.
3IDF Diabetes Atlas
4Excluding GLP-1, which in the latest market analysis are considered drugs for obesity and weight loss rather than diabetes.
5Source: IQVIA