Asia - Downside Risks to Diabetes Epidemic Outlook

22 Apr 2011 • by Natalie Aster

BMI View: South East Asia represents a moderate opportunity for pharmaceutical companies and medical device firms specialising in diabetes therapeutics and diagnostics. The region's economy is growing, resulting in rising personal wealth, increased intake of calories, rapid urbanisation, more sedentary lifestyles, ageing populations and, as a consequence, a greater prevalence of metabolic disorders. We note that across the wider Asia continent, India and China are also particularly attractive to diabetes specialists.

The number of adults with diabetes in select South East Asian countries - Indonesia, Malaysia, Philippines, Singapore, Thailand and Vietnam - is forecast to increase from 17.9mn in 2010 to 44.1mn in 2030, representing a rise of 146%. [1] The key downside risks to this projection are a slowdown in China's economy, which is a leading trade partner with the region, and a greater awareness of the chronic diseases among patients, prescribers and payers.

Predominantly Triple Digit Growth
Number Of People Aged 20-79 Years With Diabetes In Select Asia Countries In 2010 And 2030

Source: Diabetes Research And Clinical Practice 87 (2010) 4-14, International Diabetes Federation, BMI

In terms of prevalence, the most affected country is Malaysia, where 11.6% of the population has diabetes. Obesity is one of the key risk factors for diabetes and rates of this condition are increasing rapidly in both Peninsular and East Malaysia. Using World Health Organization (WHO) recommendations for body mass index (BMI), the prevalence of overweight and obese individuals was found to be 33.6% and 19.5%, respectively. [2]

At just 3.5% of the population, Vietnam has the lowest prevalence of diabetes in the region. Researchers have established that many Vietnamese with type 2 diabetes have a normal BMI, but higher levels of total body and abdominal fat. They attributed the recent increase in prevalence to a greater intake of Western-style foods and the continued consumption of polished rice, both of which have high glycemic indexes. [3]

Over the next 20 years, Indonesia will see the greatest absolute increase in adults with diabetes, rising from 3.4mn in 2010 to 16.5mn in 2030. Research published in Acta Medica Indonesia shows that the main prediction factors are age, obesity, central obesity, hypertension and a smoking habit. With the establishment of these characteristics, researchers aim to construct an epidemiological model that will assist screening tools in Indonesia's primary healthcare system. 

Driven by Growing Economies
Prevalence Of Diabetes Among Adults Aged 20-79 Years In Select Asia Countries In 2010 And 2030

Source: Diabetes Research And Clinical Practice 87 (2010) 4-14, International Diabetes Federation, BMI

A large population and low rates of diagnosis and treatment mean that Indonesia has the largest burden of diabetes in South East Asia. BMI's Burden of Disease Database (BoDD) reveals that 1,172,190 disability-adjusted life years (DALYs) were lost to the metabolic disease in the country during 2010. This burden is greater than the five other countries combined.

A Clear Outlier
DALYs Lost To Diabetes In Select South East Asian Countries

e/f = estimate/forecast. DALYs = disability-adjusted life years. Source: BMI's Burden of Disease Database (BoDD)

Even though Indonesia has the largest absolute burden, diabetes drugmakers - such as Sanofi-Aventis, Eli Lilly and Novo Nordisk - are more likely to initially target countries that have developed and concentrated pharmaceutical markets. According to BMI research, the city-state of Singapore has the region's highest annual per-capita spending on medicines (US$120), followed by Thailand (US$62), Malaysia (US$57) and the Philippines (US$30).

An Important Consideration
Per-Capita Pharmaceutical Spending In Select South Asian Countries (US$)

Source: BMI

There is a clear relationship between wealth and the burden of diabetes. BMI has established that as average per-capita private consumption increases in a country, the numbers of DALYs lost to diabetes per 100,000 population rises accordingly (R2 = 0.72). This finding will assist policy makers and pharmaceutical companies with prevention programmes and commercialisation strategies.

A Fairly Strong Link
The Relationship Between Wealth And The Burden Of Diabetes

DALYs = disability-adjusted life years. Source: BMI's Burden of Disease Database (BoDD)

Due to the lack of publicly available information, it is difficult to establish the breakdown for the burden of type 1 and 2 diabetes in South East Asia. Research conducted by Hanyang University Hospital in South Korea found that incidence rates of type 1 diabetes are 'extremely low' in Asian population compared with Caucasians.[5] If a prevalence figure of 1% is assumed (the global figure is 5-10%), this equates to patient population of approximately 180,000 in the six countries.

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