Diabetes in India - Kantar Health

DIABETES IN INDIAThe world is being gripped by a diabetesepidemic with one in 10 adults worldwidesuffering from the disease, which is amajor cause of premature death. Globally, Indiais estimated to have the highest incidence ofdiabetes with 50.8 million people living with thecondition: China is catching up with 43.2 million.Both countries have outpaced the US in incidenceof diabetes to become joint ‘diabetes capitals’ ofthe world. This trend is expected to continue, withIndia and China making up nearly 50 per centof the worldwide diabetes population by 2030.In high-income countries like the US, 85-95per cent of all diabetes patients have Type 2diabetes. The percentage is even higher incountries like China and India, with recordprevalence of Type 2 predicted for 2030; 101million in India, 130 million in China versus 30million in the US, according to the InternationalDiabetes Federation’s Diabetes Atlas 5th Edition.Like China, where a mere 3.05 per centof patients report having Type 2 diabetesand only a third (even in urban areas of thecountry) are diagnosed (far fewer than theaverage of just less than 50 per cent in therest of the emerging markets), prevalencefigures in India are slightly skewed becausethe disease often goes undiscovered.One-third of Indian patients were diagnosed ‘byaccident’, according to D-Picture, 2012 – a 360degree research programme to understand Type 2diabetes patients in India, looking at demographicPlagued by accidental diagnosis and lack of patient compliancethe diabetes epidemic rages on in IndiaIndia vies with China and US for diabetes capital of the world(2030 population)ChinaIndiaUSIn India, lack of awareness of Type 2diabetes is commonplace...…and patient education hasstill a long way to go to stemthe epidemic...130m101m30m93% 59% 67% 60%are not awareof their BMIof patientsranked “highstress” as aprimary causeOnly 1 in 3 knew the typeof diabetes they have3 in 4 patients havenever had an HbA1ctesttreated patientsregularly miss adosedo not takemedicationbecause oftheir attitude…and traditional communicationsmethods would do little to changetheir attitude and behaviourInfluencers 25%Aspirers 51%Functionals 1%Networkers 2%Communicators 6%Knowledge seekers 15%However, when segmentingpatients on the basis oftheir digital engagementlevels, over 75% showedhigh engagement levels.Is digital communication the key to Type 2 diabetes compliance in India?thout changes accompanied Pharmaceutical by this copyright notice. Market Europe November 2012 www.pmlive.com/pme 31

DIABETES IN INDIAtrends, symptoms, diagnosis, treatment anddisease monitoring processes and involving 1434patients across 15 Indian cities (including Mumbaiand Delhi) and tier one towns (eg, Jaipur,Hyderabad, Lucknow, Cochin.“ … in China and Indiarecord prevalence of Type 2is predicted for 2030 … ”Family history also has a part to play … or doesit? Unlike diabetes hot spots like China and theUS – where risk factors are often hereditary –almost two-thirds of the Indian patients KantarHealth spoke to who had developed diabetesdid not have a family history of the disease.Although this discrepancy could be attributed tothe lack of formal records, this is unlikely to bethe case – were it so you would also expect to seesimilar trends in patients in rural areas in China.Cost and treatment coverageCost of care is a potential issue in India and isimpacting both diagnosis and treatment. Around50 per cent of our sample were either employed orself–employed, and just 7 per cent had employerrelatedinsurance to cover their treatment.Medical insurance penetration in India is generallylow, even among more affluent patients, anddiseases such as diabetes are often not coveredby insurance policies. The region also suffers froma lack of investment in treatments: less than 1 percent of worldwide diabetes spending is spent inIndia compared with the US, which accounts forover half of worldwide diabetes expenditure.“Medical insurancepenetration in Indiais generally low, evenamong affluent patients”As well as putting pressure on healthcareexpenditure, the economic burden – lostproductivity and economic growth – of diabeteslooms large, with the greatest burden being thecosts associated with disability and loss of life asa result of the disease and its complications.The World Health Organisation (WHO) predictednet losses in national income from diabetesand cardiovascular disease of Int$557.7bn inChina and Int$336.6bn in India between 2005and 2015. In India around 70 per cent of Type2 diabetes patients were diagnosed when theywere under 50 years-old, suggesting that theirworking life was likely to be cut short.Poor disease awarenessAlongside affordability and the lack of treatmentfunding, poor awareness of the disease isimpacting the treatment pathway. Type 2diabetes can remain undetected for many years,and diagnosis often results from associatedcomplications or accidently as the result ofan abnormal blood or urine glucose test.A recent social media study conducted amongdiabetes patients in China found they take theirdisease seriously, with over three-quarters goingonline to discuss the pros and cons of therapies,diet and lifestyle. However, it seems that Indianpatients do not have the same approach. Onlyone-third of our Indian sample could correctlyidentify the type of diabetes they have, and 93per cent were not aware of their BMI. Although50 per cent of the Indian sample was overweight(compared with a whopping 90 per cent in the USand 41 per cent in China) and recognised weightas a contributing factor in their disease state,they blame stress as being the main cause.“Alongside affordability… poor awareness ofthe disease is impactingthe treatment pathway”Patients in China and the US are activelyseeking out solutions and educational helpfor their diabetes. However, a traditionalsegmentation of patients in India revealed that37 per cent fell into the ‘careless and casual’category and another 18 per cent into the ‘defiantnon-followers’ segment, meaning that over 50 percent of our sample were in denial and/or lackedthe discipline required to comply with prescribedtreatment regimen. Three out of four had neverhad an HbA1c test and while most compliedwith doctor and specialist recommendationsregarding frequency of diagnostic tests, doctorvisits and brands purchased, around 64 per centskipped doses. Most patients were not taking anycorrective actions in terms of diet and lifestyle.Engaging the non-engagedThese non-compliant patient groups shouldbe targeted with marketing campaigns andmessages that are different from thoseaimed at compliant patient segments. Buthow can pharma influence patients in Indiawho don’t want to comply or are in denial?In common with their counterparts fromChina and the US, diabetes patients in Indiaare increasingly connecting with otherpatients using social media and other onlinecommunication tools. A random sample of1,030 Type 2 sufferers in urban India showedthat 12 per cent go online at least once a week32 www.pmlive.com/pme Pharmaceutical Market Europe November 2012

DIABETES IN INDIA– a figure that is growing rapidly. Specialistcommunity sites like D-book enable patientsnot only to share their experiences with fellowpatients but to benefit from doctors’ expertiseusing video conferencing and online discussion.“ … diabetes patients in Indiaare increasingly connectingwith other patientsusing social media …”Because wealthier Indian patients tend to haveaccess to the internet, patient types in Indiawere re-segmented using the Digital Life (www.tnsdigitallife.com/) online classifications todetermine the extent of stakeholders’ activityand engagement online, and to see whetherusing mainly online communications wouldimprove patients’ engagement and compliance.Almost three-quarters of the sample havestrong engagement in digital campaigns.Interestingly, over half of the Indian patientgroup, including non-compliant patients, fellinto the ‘aspirer’ category with high onlineinvolvement. Therefore, they would be open tothe use of social media and online chat for diseaseeducation and marketing even although theydid not use these channels as much as some ofthe other groups. Another quarter of patientswere power internet users or ‘influencers’.Pharma companies looking to educate Type 2diabetes patients in India or encourage them tocomply with a treatment regimen should explorehow to get messages across digitally. It will alsobe particularly important to utilise available datato monitor changes in epidemiology, patienteducation and both health-related quality of lifeand economic outcomes across all the diabeteshotspots. While stopping the spread of the diseaseisn’t possible, we can at least choose the bestmeans to educate patients, help them come toterms with their disease, and help them managetheir symptoms to achieve a better quality of life.The AuthorReena Thapar is a research managerat Kantar Health. She can be contactedat reena.thapar@kantarhealth.com.Diabetes prevalence (%)Adults aged 20-79 (in 1,000s)Adults with diabetes aged20-79 (in 1,000s)Africa 3.80 386,298 14,722Europe 8.08 653,233 52,771Middle East/North Africa 9.15 356,438 32,603North America 11.72 321,968 37,737South America 8.68 289,539 25,134Southeast Asia 8.34 856,282 71,407Western Pacific 8.54 1,544,462 131,896Source: International Diabetes Federation 2012Rank* In millionsCountryT2DPopulation*Source: International Diabetes Federation 20122011 2030 2030 minus 2011Prevalence(%)T2DPopulation*Prevalence(%)A T2DPopulation*A in T2DPrevalence1 India 61.3 8.3 101.2 9.9 39.9 1.6%2 China 90.0 9.3 129.7 12.1 39.7 2.8%3 Bangladesh 8.4 9.6 16.8 13.3 8.4 3.7%4 Brazil 12.4 9.7 19.6 12.3 7.2 2.6%5 Mexico 10.3 14.8 16.4 17.6 6.1 2.8%6 USA 23.7 10.9 29.6 11.8 5.9 0.9%7 Pakistan 6.3 6.7 11.4 7.8 5.1 1.0%8 Egypt 7.3 15.2 12.4 17.8 5.1 2.7%9 Indonesia 7.3 4.7 11.8 5.9 4.5 1.2%10 Iran 4.7 9.3 8.4 13.1 3.7 3.8%Pharmaceutical Market Europe November 2012 www.pmlive.com/pme 33