Type 2 Diabetes

Type 2 diabetes is a metabolic disorder in which the insulin secretory response to glucose is impaired together with its effectiveness to stimulate glucose uptake by skeletal muscle and to restrain hepatic glucose production (insulin resistance), all of which combine to produce raised blood glucose levels (hyperglycemia). In turn, this may lead to organ damage involving the kidneys (diabetic nephropathy), nervous system (diabetic neuropathy), eyes (diabetic retinopathy) and circulatory system.  Although there are clear benefits to reducing glucose levels and many antidiabetes options are available, treatment remains inadequate.

Diabetes is a major threat to global public health that is rapidly getting worse. There are more than 220 million diabetics worldwide, with approximately 90% suffering from type 2 diabetes. In 2005, an estimated 1.1 million people died from diabetes (although the actual number is likely to be much larger, because although people may live for years with diabetes, their cause of death is often recorded as heart disease or kidney failure which are actually a consequence of their diabetes). It’s estimated that approximately 8% of the US population (23.6 million people) suffer from type 2 diabetes. Type 2 diabetes is largely the result of excess body weight and physical inactivity. Type 2 diabetes is often part of a metabolic syndrome that includes obesity, elevated blood pressure, and high levels of blood lipids. About 80% of people with type 2 diabetes mellitus are overweight.

In 2008 global sales of anti-diabetics were worth more than $20 billion, and grew by 12%, and is expected to grow to $38 billion by 2018. Insulins and glitazones are the largest product classes, and comprise 73% of the total anti-diabetic market value. Additional classes of anti-diabetic agents are expected to be introduced by the end of the decade. By 2018 these new classes are expected to account for as much as 32% of the global anti-diabetic market. As for the two classes accounting for the most units sold, sulfonylureas and biguinides are now both without patent protection, therefore new classes with new advantages become important to maintain growing industry revenues (Source: Datamonitor; Commercial Insight - Antidiabetics 2009).

Obesity

“Overweight and obesity have become to diabetes what tobacco is to lung cancer” ¹. The rise in obesity is one of the greatest challenges in the 21^st century. The World Health Organisation (WHO) defines overweight and obesity as abnormal or excessive fat accumulation that may impair health. Body mass index (BMI) is a simple index of weight-for-height that is commonly used in classifying overweight and obesity in adult populations and individuals. It is defined as the weight in kilograms divided by the square of the height in meters (kg/m²). “Overweight” is defined as a BMI equal to or more than 25, and "obesity" as a BMI equal to or more than 30.

On a global scale the WHO estimates that more than 1.6 billion adults are overweight, and at least 400 million are clinically obese. The costs to healthcare systems are enormous, highest is the United States where the costs run up to 9% of the national budget (equivalent to $93 billion/year). In Europe up to 8% of health costs are due to obesity in adults.

The market for anti-obesity drugs is rather premature in terms of number of drugs approved; global sales in 2008 were approximately $500 million. However the future, as seen by many analysts, does have significantly large growth potential.

1. Yach D, Stuckler S, Brownell D: Epidemiological and economic consequences of the global epidemics of obesity and diabetes. Nat Med 12:62-66, 2006