A national survey of diabetes prevalence and control in China – the most comprehensive survey to date – has estimated overall prevalence within Chinese adults at 11.6%, or 114 million people, 22 million people higher than a previous 2007 estimate, and the pre-diabetic population is estimated at a staggering 50.1%.
IHS Global Insight perspective | |
Significance | The most comprehensive national survey of diabetes and glycaemic control in China, estimates disease prevalence at 11.6%, or 114 million people, 22 million higher than an earlier 2007 survey, and meaning that one-in-three of the world's diabetics are Chinese. |
Implications | The disease is reaching epidemic proportions in the country, driven by lifestyle and dietary changes caused by increasing wealth and urbanisation. |
Outlook | The revised Essential Drug List issued earlier this year included a number of diabetes treatments from multinational firms as the government seeks to contain spending, with the country now a key battleground for multinational pharma firms. |
The study "Prevalence and Control of Diabetes in Chinese Adults", published yesterday (4 September) in the Journal of the American Medical Association (JAMA), employed a complex, multi-stage, probability sampling design to conduct a cross-sectional survey of a nationally representative sample of 98,658 Chinese adults in 2010. The study's authors included researchers from Beijing's Chinese Center for Disease Control, the China Noncommunicable Disease Surveillance Group, and the United States-based Johns Hopkins University.
Under-diagnosed and undertreated
Participants' plasma glucose and haemoglobin A1c (HbA1c) levels were measured after at least 10-hour overnight fast, and a two-hour oral glucose tolerance test was conducted on non-diabetics. Employing the 2010 American Diabetes Association definitions of diabetes and pre-diabetes, the study estimated overall prevalence of diabetes at 11.6% in the Chinese adult population – 12.1% among men, and 11.0% among women – equating to 114 million people.
With only 3.5% of those surveyed having previously been diagnosed, the undiagnosed prevalence rate was 8.1%. The level of pre-diabetes was put at 50.1% overall, with 40% of the 18–29 age group classed as pre-diabetic, and 47% of those aged 30–39. Those most likely to be suffering from diabetes are urban residents, older age groups and those living in wealthier provinces. In terms of treatment, the survey found only 25.8% of diabetics in China were receiving treatment for diabetes, and of those only 39.7% achieved adequate glycaemic control.
Outlook and implications
The study adds 22 million to a previous 2007 study that put diabetes prevalence in China at 9.7%, or 92.4 million adults, and indicates an epidemic of worrying proportions for the Chinese government (source: International Diabetes Federation). Although researchers did note that the expanded terms of the 2010 survey may have been responsible for some of the increase in numbers, the pace of increase is staggering, rising from an estimated only 1% prevalence in 1980. As well as having the largest population of diabetics, the disease is now more prevalent in China than the United States, where 11.3% of the population is diabetic. The study also highlights that the Chinese would appear to be more vulnerable to developing the condition due to lifestyle and dietary changes: the average survey participant had a body mass index (BMI) of only 23.7, compared with 28.7 in the United States. The greater burden among the young and middle-aged also indicates the epidemic will worsen in future. This will see an increased burden on the health system from diabetes-related diseases including stroke, cardiovascular disease, and chronic kidney disease.
China is already a key battleground for multinational pharmaceutical firms for diabetes products, and the report underlines that double-digit growth in the market can be expected for some years: the total oral non-insulin anti-diabetic market was USD875 million in 2012 (source: IMS), but could reach USD2.1 billion by 2019, according to industry analysts. Lack of patient spending power means medicines no longer used in the West can achieve significant sales in China, with Bayer (Germany)'s Glucobay (acarbose) the leading non-insulin drug in 2012, recording USD283.4 million in sales and 22% growth, according to the firm. The government is taking steps to improve access to drugs for patients, with Glucobay included on the revised Essential Drug List (EDL) earlier this year, along with Amaryl (glimepiride; Sanofi, France) and human insulin (Sanofi's Lantus), joining metformin and animal insulin. It remains to be seen whether the tougher pricing competition for EDL tenders is offset by higher volume sales for these drugs. Firms looking to offer newer treatments to patients must wait three years from market launch to be eligible for inclusion on the national reimbursement lists, with only around 10% of patients able to pay out-of-pocket for non-reimbursed products.
The complexity of the market has seen a number of partnerships formed, with recent deals of note including Sanofi and Takeda (Japan) in relation to the latter's Nesina (alogliptin), and Bristol-Myers Squibb (US) and AstraZeneca (UK) for Byetta (exenatide), while local firms looking to challenge the multinationals include Wanbang Pharma (see Japan - China - France: 24 April 2013: Sanofi and Takeda join forces in China's type 2 diabetes market; United States - Japan - China - United Kingdom: 10 April 2013: BMS, AstraZeneca diabetes alliance gets under way in China and Japan and China: 20 August 2013: Canada's Sirona Biotech turns to Wanbang Pharma for Chinese development of SGLT-2 inhibitor).
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