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Dealing with the surge

Anti-diabetic drugs, digitalisation of treat ent modalities and innovation of devices, are likely to transform  diabetes  treatment in India. Predicting the onset of diabetes analysing large amounts of data and enabling early  intervention, will have the potential to advance diabetes treatment

India has around 101 million people living and struggling with the dreaded disease diabetes. According to ICMR research, close to 136 million people are already in the pre-diabetic stage and these numbers are projecting a grim situation. What’s even more worrisome is that these numbers are poised to touch a whopping 134.5 million supposedly by 2045 as per recent research. A recent study by Mumbai-based startup Fitterfly has released data from the analysis of approximately 16,000 digital interactions involving individuals with pre-diabetes and diabetes.

Conducted over a year using the platform’s diabetes reversal calculator, the analysis provides valuable findings. Among the key findings, it was revealed that 30 per cent of the analysed individuals had HbA1C levels above 9.5
per cent. Such high HbA1C levels can cause several complications, making it necessary to take immediate action. Surprisingly, 22 per cent of the 30 per cent with these high levels took no medication and were looking
for alternatives.

Dynamics of the diabetes care market

The phenomenal increase in diabetes patients is primarily due to the Indian genetic predisposition combined with unhealthy lifestyle habits, urbanisation, globalisation etc. The diabetes management market is broadly segregated into oral antidiabetic and insulin is slated to rise also due to low-cost drug manufacturing. The market is inundated with multiple options available for insulin drug delivery from basic insulin drugs, bolus or fast-acting insulin, traditional human insulins, biosimilar insulins and insulin combinations, to even insulin devices which include pumps, pens, syringes and insulin jet injectors.The role of anti-diabetic drugs

The market holdings for the Indian diabetes drug market seem extremely impressive.The growing need for anti- diabetes drugs has propelled the steady growth of this sector. According to Mordor Intelligence, the anti-diabetes market size stands at $1.64 billion and is expected to increase to1.94 billion by the year 2028. Glenmark Pharmaceuticals has launched in India the first triple-drug fixed-dose combination (FDC) of the widely-used Teneligliptin with Dapagliflozin and Metformin to improve glycemic control in patients with Type 2 diabetes.

Says Alok Malik, President & Business Head -India Formulations, Glenmark Pharma, “India has the second-largest  diabetic population in the world and Type 2 diabetic patients here often face issues of uncontrolled   emoglobin A1C (HbA1Ci), beta cell dysfunction, which impairs insulin secretion, along with other co-morbidities like weight gain. Diabetes management, hence, becomes difficult for these patients and a challenge for healthcare  providers.”

New Delhi-based Akums Drugs and Pharmaceuticals has unveiled a pioneering solution in the fight against  diabetes – Vildagliptin SR and Metformin SR tablets. Designed to cater to patients with type2 diabetes mellitus  who have found inadequate control with metformin monotherapy, this revolutionary combination promises effective glycemic control and represents a remarkable advancement in diabetes treatment.  It may also be noted that

Mumbai-based Lupin has announced the acquisition of diabetes brands ONDERO and ONDERO MET,  from Boehringer Ingelheim International including the trademark rights associated with these brands. Dr SK Hammadur Rahaman, Endocrinologist and Diabetologist, Medica Superspeciality Hospital says, “In terms of treatment, anti-obesity medications such as SGLT2 inhibitors are gaining favour due to their dual benefits in diabetes and weight
management. GLP-1 analogues, such as Semaglutide, are viable choices.”

The digital revolution
Digitisation seems to have paved roads even into the diabetes care and management sector fuelled by the digital India initiative of the government. The Indian diabetes management market structure in the 21st century is driven by path-breaking technologies and revolutionary devices that are changing the spectrum of diabetes care.

Says Dr Shashank Joshi, President, India Academy of Diabetes, Ex- Chair, International Diabetes Federation,  “Though diabetes care with the discovery of Insulin happened more than 102 years ago, the technology adopted for the same was very skewed. With the covid pandemic, technology adoption accelerated. Using digital tools like AI, it is possible to create a digital model and create customised solutions for the patient. “We can use precise  therapy with the era of evidence-based medicine now in place. You can pick the data, analyse the same and give solutions for individual patients.”

Leveraging technology and data analysis is the way ahead for achieving better health outcomes for patients.  Digitisation of diabetes care has led to a niche segment ie personalised and patient-centric diabetes care which helps clinicians and those afflicted to make informed decisions during their journey towards a cure. To achieve a patient-centric care regimen, technology does not just work in silos, it works in conjunction with behavioural science to understand the needs, concerns and challenges w.r.t to using a device/ technology.

Artificial Intelligence (AI) has paved the way for a host of new opportunities in the diabetes care segment. AI and its applications like Machine Learning (ML) are indeed promising technology which can help those afflicted with the disease, slow down the progression of the disease and its complications and delays the onset of those who are undiagnosed.

Harnessing the ability of AI to process large amounts of data with accuracy as well as their advanced algorithms, will prove advantageous to improve prognostic decision making and accuracy in diagnostic testing. Dr Narendra Prasad, Senior Consultant, Internal Medicine and HIV medicine, Cytecare hospitals opined, “Nanotechnology, stem cell technology, gene therapy and medical nutrition therapy are some of the newer treatment modalities that inspire confidence in tackling this global epidemic.”

Diabetes devices -Market Monopoly
Due to the high prevalence of the disease in the Indian subcontinent, diabetes care in India relies heavily on devices. Blood glucose monitoring (BGM) and continuous glucose monitoring (CGM) have made tracking blood sugar a seamless experience. Tina Deng, Principal Medical Devices Analyst, GlobalData, mentions, “Diabetes care devices have witnessed massive demand due to the increase in the prevalence of diabetes and growing
awareness among consumers regarding the availability of new technological advancements in the market. CGM  has become crucial for people with insulin- dependent diabetes over the past few years.”

Dr Johan Vargehese, Endocrinology Department, Holy Family Hospital, Mumbai cited the ever-growing importance  of CGMs in the diabetes care domain today. He said, “Of late with the advent of continuous glucose monitors which is a patch placed on the skin we can note over 14 days of the glucose trends over 24 hours thus giving a very important metric known as glycemic variability which has shown clinical significance in overall health.”

The insulin drug delivery devices segment is on the threshold of rapid changes. Technological advancements have fuelled the growth of this sector with the introduction of high-end insulin pumps and pens. In the recent past, the pandemic has also had a profound impact on the diabetes devices market due to the demand for remote monitoring of patients.

Precision with insulin pens
Given that Insulin is a tricky hormone to deal with, delivery of insulin needs to be made in a precise and accurate  manner and also needs to be minimally invasive. In the wake of limitations posed due to insulin delivery via syringes, various advancements have been made which are patient-friendly, accurate and convenient to use.

Omar Sherief, Cluster Head – India Middle East and Africa of Roche Diabetes Care, mentioned, “An important  part of successful diabetes management is regular and timely insulin delivery. The process of injecting is sometimes unpleasant for people with diabetes, causing fear. This often leads to insulin initiation delay which is  closely associated with poor glycemic control and further clinical complications.”

Roche Diabetes has made a radical move in this domain coming up with the virtually painless mode of insulin delivery. Medtronics, one of the key players in the global diabetes devices market, introduced the InPen which is integrated with real-time guardian connect to continuously monitor blood glucose levels. A step further in the connected pen technology domain is the introduction of closed-loop systems that are being looked at to automatically adjust insulin doses.

Goal setting by the govt
The Indian government has relentlessly supported the medical fraternity in combating and controlling the surge in numbers in the recent past. Under the National Program for Prevention and Control of Cancer, diabetes, Cardiovascular Diseases and Stroke (NPCDCS), the Department of Health and Family Welfare provides technical and financial support to states and UTs to alleviate the burden of diabetes on the economy. The GoI recently into its 75th year, has etched out a roadmap to scale up hypertension and diabetes care services by 2025.

The Union Health Ministry has launched an ambitious initiative of screening and putting 75 million people with hypertension and diabetes on Standard Care by 2025. Under various initiatives like the PMBJP – Pradhan Mantri  Bharatiya Janaushadhi Pariyojana and the free drugs initiative, free essential medicines like insulin and generic medicines are provided to needy patients. Under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY), free in- patient care is given to patients below the overty line in government hospitals. The government has backed the Department of Biotechnology under the chronic disease programme by setting up various projects to arrive at a consensus and a novel approach to contain the silent killer. Projects are being initiated to  understand the molecular mechanisms and genetics behind the working of this disease.

A positive future beckons Public Health Foundation of India (PHFI) in association with Dr Mohan’s Diabetes Specialities Centre and Madras  Diabetes Research Foundation (MDRF), Chennai, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Emory University and Harvard University from the USA, has announced the findings of India’s first-of-its-kind in-depth corporate worksite report titled ‘INDIA- WORKS’ – Integrating Diabetes Prevention in Workplaces. Conducted over six long years (2016-2022), which makes it one of the longest-surveyed reports in  the corporate world, the INDIA-WORKS report highlights the need for strategic health-based interventions at company worksites to ensure employees’ overall well-being through a structured lifestyle modification programme.

Says Dr Preethi Kumar Goyal, VP Medical Services, MediBuddy, “Diabetes management stands on the brink of  transformation, where innovative technology promises a brighter future. As the global prevalence of diabetes continues to rise, the demand for patient-centric solutions has never been more critical. Personalised medicine using genetic testing for risk prediction, pharmacogenomics, behavioural techniques, and personalised lifestyle advice is the future of diabetes management.”

The goal of every stakeholder in the diabetes care community should be towards working out a more positive future in terms of treatment satisfaction and quality of life. The pipeline for ongoing research in India is impressive and shows us that there is indeed light at the other end of the tunnel and all is not grim.

— By Sonali Patranabish

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