An Undesirable Trend: The Global Outlook on Diabetes

November 14, 2011 marked both the celebration of the 20th annual World Diabetes Day and the release of the fifth edition of the International Diabetes Federation’s (IDF) Diabetes Atlas. Euromonitor International analyses the IDF’s report and its implications for the global consumer health market.

Bad news and more bad news

The IDF estimates that in 2011 366 million adults (20-79 years) have diabetes. By 2030, the number is expected to increase to 552 million, or approximately 10% of the global adult population. Several million more are also at risk for developing the disease. Impaired glucose tolerance (IGT), or pre-diabetes, is a condition in which blood glucose levels are elevated higher than normal, but lower than the diabetes threshold. The global prevalence of IGT is currently about 6.4% and expected to rise to 7.1% by 2030. Though pre-diabetes is obviously less serious than diabetes, it still poses very real health risks. For example, pre-diabetics are 1.5 times as likely (versus 2-4 times for diabetics) as non-diabetics to develop cardiovascular disease.

Just as discouragingly, diabetes is becoming increasingly common in developing countries and regions previously less affected by the disease. In fact, 80% of diabetics live in low- and middle-income countries. In Bangladesh, the number of people living with diabetes is expected to double between 2011 and 2025, while the Middle East and North Africa region hosts six of the 10 highest prevalence countries in the world. Although starting from a much lower base, diabetes prevalence in Africa is expected to increase 90% between 2011 and 2030. The Zanzibar Minister of Health reported in November 2011 that more Zanzibaris are being diagnosed with diabetes than communicable diseases like malaria and HIV.

Those living in developing countries are likely to experience more striking lifestyle changes than those in developed areas. Unfortunately, some of these changes, such as increases in the consumption of highly processed foods and decreases in activity level, contribute to the incidence of diseases like diabetes, which in turn threatens economic growth. Diabetes leads to both increases in health care costs and decreases in productivity; the Chairman of the Diabetes Association of Jamaica, for example, specifically warned in November 2011 that diabetes and other such diseases will negatively impact economic productivity if not effectively controlled. The World Economic Forum estimates that economic losses to low- and middle-income countries from diabetes and other non-communicable diseases over the period 2011-2025 will be equal to about 4% of these countries’ annual output in 2011.

Consequences for overall health

Type 2 is the most common form of diabetes. It results when the body’s insulin is insufficient or fails to transport glucose (sugar) from the blood into the cells. In addition to genetic causes, it is widely understood that excess weight and low levels of physical activity are key risk factors for developing the disease. Perhaps less obvious is that smoking is as well. A 2007 Journal of the American Medical Association study found that smokers had a 44% greater risk of diabetes than non-smokers. For heavy smokers (those who smoke at least 20 cigarettes a day), the risk jumps to 61%. This is significant because the build-up in blood sugar that occurs in Type 2 diabetes can lead to a wide-ranging variety of health complications.

The US Centers for Disease Control and Prevention reports that diabetics are twice as likely to develop serious gum disease as non-diabetics. In addition, certain diabetes medications may cause dry mouth, which likely contributes to the accumulation of dental plaque and periodontal disease risk. Periodontal disease may also affect blood sugar levels, making it more difficult to manage diabetes.

People with diabetes are generally more vulnerable to bacterial infections, which explains the greater incidence of periodontal disease. It also explains the ubiquity of skin infections in diabetics. Wounds are slower to heal, and non-bacterial skin conditions are very common as well. Persistent foot wounds are particularly widespread because nerve damage can cause loss of sensation, allowing wounds to go unnoticed and untreated, and poor circulation can make it more difficult to fight infection. In the most extreme cases, this may even lead to amputation.

In addition, people with diabetes are twice as likely to develop cardiovascular disease or have a stroke. They are more prone to kidney disease, vision issues (such as glaucoma and cataracts), and hypertension. Surprisingly, they also experience greater rates of hearing loss; the US National Institutes of Health has found that hearing loss is twice as common in diabetics and 30% more common in pre-diabetics than those with normal blood sugar levels. A September 2011 study in the journal Neurology even discovered that diabetes and pre-diabetes are associated with a higher risk of dementia and Alzheimer’s disease.

Consumer health opportunities

The IDF’s stark projections should motivate public health officials, consumers, and other organisations to increase their focus on diabetes prevention and treatment. Indeed, many consumer health companies are already responding to the trend. In March 2011, Fero Industries in partnership with the local subsidiary of Merck KGaA introduced a blood sugar control medication called Sucanon for Over-the-Counter (OTC) use in Mexico; it is also available in Peru, but by prescription only. PharmaCline is targeting wound care for diabetics and pre-diabetics with the release in November 2011 of three new OTC topical antibiotics. Retail pharmacies are also pursuing diabetic customers. Rite Aid, partnered with WebMD, launched its wellness+ for diabetes program in September 2011. It includes education initiatives, online health management tools, and e-newsletters with updates on diabetes research and coupons for diabetes-related products. Health Mart pharmacies decided to launch its private label in November 2011 with a line of OTC diabetes care products.

Vitamin and dietary supplement producers are trying to capitalize on the diabetes market, too. Multi-betic, Nature Made, Nature’s Bounty, Carlson, and Spring Valley, among others, all offer daily multivitamin supplements or health/support/nutrition “packs” aimed at diabetic and pre-diabetic consumers. A couple of recent studies support the benefits of other dietary supplements. A May 2011 study in the American Journal of Clinical Nutrition found that diets high in non-marine omega-3 fatty acids may protect against diabetes, while separate studies at Tufts University and in the journal Diabetes Care found that Vitamin D deficiency may increase diabetes risk.

Weight management, nicotine replacement therapy smoking cessation, and adult mouth care products may all see an increase in use for preventive care. Diabetes-specific pain relief products, such as Zostrix Diabetic Foot Pain Relieving Cream and Walgreens Nerva Pain, and skin care items, such as Neoteric and Diabeti-Derm, can facilitate self-care. Even less obvious OTC product categories are being marketed specifically to diabetic consumers. For example, both Scot-Tussin (Pharmacal Co Inc) and Diabetic Tussin offer cough and cold medicines that are “safe for diabetics.” Hopefully, this is a case where prevention and treatment, coupled with increased awareness and lifestyle changes, will reverse a trend that is anything but promising.