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Type 2 diabetes poses one of the greatest public health threats of the 21st century. As well as increasing the potential patient population, type 2 diabetes has also raised the profile of the disease. However, a new Datamonitor report estimates that while 55 million people are affected by type 2 diabetes, only 50% of patients are diagnosed, and only 80% of those actually receive treatment.
The majority of the western world is in the grips of a diabetes epidemic - driven by type 2 diabetes - that goes hand in hand with the escalating incidence of obesity. However, alarmingly, in some working class and poor communities, the disease is so prevalent that its victims almost take it as a matter of course. .
Diabetes is one of the principal causes of blindness, kidney disease, heart attacks and strokes, as well as non-traumatic amputations. The diabetes epidemic has unfolded in conjunction with the ageing global population and rapid cultural changes such as increasing urbanization, dietary changes and decreased physical activity. Datamonitor found that diagnosis rates for type 2 diabetes across the seven major markets ranged from 58% in Germany to a worryingly low 37% in France.
Type 2 diabetes is harder to detect because patients may remain asymptomatic for a long time. As a result, type 2 diabetes is usually only diagnosed as part of a routine check-up, or diagnostic tests initiated as a result of a different condition.
The WHO predicts that developing countries will bear the brunt of this epidemic in the 21st century, with approximately 80% of all new cases of diabetes expected to appear in developing countries. The prevalence of diabetes in these countries is anticipated to reach 330 million by 2025, representing 76% of the total number of people with diabetes worldwide.
The American Diabetes Association predicts that the cost of diabetes will exceed $192 billion in the US in 2020, and the direct cost of diabetes care alone is currently estimated to be $100 billion. Needless to say, there is vast market potential for drugs that can reduce this cost burden.
Diabetes remains one area of the cardiovascular franchise where there is opportunity for growth. Although there are a number of well-established classes of anti-diabetic medications, there is a residual unmet need for an effective, safe drug therapy with the ability to halt or reverse disease progression. It is predicted that by 2016 a large proportion of the top 10 cardiovascular brands will be diabetes therapies.
Particular interest has been shown in the novel classes of incretin mimetics - GLP-1 agonists and DPP-4 inhibitors - that have shown some potential to improve time to secondary failure through pancreatic B-cell salvage; drugs like Merck's Januvia and Amylin/Lilly's Byetta are likely to be adopted by international guidelines and recommended treatment algorithms in the near future.
However, novel compounds are to come under ever-careful scrutiny in terms of long-term safety data. The thiazolidinedione's (TZDs) recently found themselves in the spotlight when GlaxoSmithKline's Avandia's safety was brought into question by Dr Steve Nissen's meta-analysis that associated it with increased risk of ischemic events. This means that physicians and the FDA may require new drugs to stand the test of time before they recommend or initiate them at first- or second-line therapy.
The only non-pharmacological treatment available for type 2 diabetes is dietary advice and the initiation of exercise/weight loss regimes. If aggressive lifestyle modifications are implemented early enough, they can be enough to prevent disease progression, and even reverse the disease. However, as with most diseases, prevention is better than cure. Governments now realize the scale of the obesity problem and recognize the need to take action to combat this super-size scenario.
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