Sweet no more

The diabetic population in India is growing and everyone wants a piece of the sweet pie. With insurance providers, diagnostic companies, hospitals and pharma companies focussing on this segment, Nandini Patwardhan tries to ascertain the potential of the diabetes market

It was a surprise when ICICI Prudential Life Insurance, one of the many insurance players in India, launched a product known as 'Diabetes Care'. Speaking at the launch, Shikha Sharma, CEO and Managing Director, ICICI Prudential Life Insurance, stated, “With over 20 percent of the world's diabetic individuals in India, there is an urgent need for a solution that both encourages them and gives them incentives to manage their condition better, as well as offers them a financial cushion, should they suffer from any related critical illnesses.” “These are the key requirements we have taken into account while developing Diabetes Care,” she added.

"We realised that despite the huge need, there was no insurance product specifically tailored for diabetic individuals" - Shikha Sharma CEO and Managing Director ICICI Prudential Life Insurance

Another reason for launching a product in this segment seems to be the quantum of the diseased population, which seems to increase with the day making it a lucrative segment. Traditionally, the diseased population does not get a policy cover. And even if they do, they have to pay a high rate of premium in order to get insured. ICICI Prudential Life Insurance, having recognised this cover gap, has come up with a strategy to tap this population. Diabetes Care which will cater to people already suffering from Type 2 diabetes or impaired glucose tolerance or impaired fasting glucose, is structured to provide a co-ordinated care proposition to help the insured manage diabetes, while providing financial support to meet the cost of health complications.

"When we scanned the global environment, we realised that despite the huge need, there was no insurance product specifically tailored for diabetic individuals. Diabetes Care is truly an innovation for both us and the global life insurance market and it marks a paradigm shift in insurance product structures from cost pooling to overall cost reduction," reveals Sharma. Also, diabetes is one disease that leads to many others like cardiovascular, kidney, eye and foot disorders. The product is thus structured to provide help to the insured manage the diabetic condition, while providing financial support to meet the cost of health complications. The product's support system includes comprehensive annual check-ups and consultations with doctors, home collection of samples for blood tests and helplines for access to resources, and co-promotion and servicing of support groups. ICICI Prudential is also entering into partnerships with leading pharmaceutical companies, diagnostic labs, gymnasiums and dieticians.

Hospitals like the Arvind Eye Hospital have organised free, on the spot blood screening tests for diabetic patients. Roche Diagnostics is also targeting the rapidly increasing diabetic populace with a range of Accu-check diagnostic kits. "In India we offer to the end user, ccu-Chek Active, which is a fast, accurate and reliable blood glucose monitor. The Accu-Chek Active system has been developed to cater to the individual needs of people with diabetes and their healthcare professionals," explains Sanjay Gupta, Head, Business Unit Diabetes Care, Roche Diagnostics India. This system, which consists of a Blood Glucose Meter, test strips, lancing device and lancets takes around five seconds of time and small amount of blood for each test thereby giving its user a pain free experience.

"Insulin contributes to more than 95 percent of our business and it is growing at a much faster rate" - Melvyn Oscar D'Souza Managing Director Novo Nordisk India

Novo Nordisk whose main focus is diabetes, offers a complete range of human insulin and analogue products. The company offers delivery devices for insulin (Flexpen, Novolet, Penfills used in NovoPen. It has also been very active in medical education for doctors, patient education programmes and nurse education programmes. "Novo Nordisk is global leader in diabetes care and is offering products for diabetes care since 1923. Insulin contributes to more than 95 percent of our business and it is growing at a much faster rate,” asserts Melvyn Oscar D’Souza, Managing Director, Novo Nordisk India. There are several products in areas of diabetes that are undergoing trials internationally and in India.

In clutches of the disease

While the number of diabetic products and diabetic offerings by companies are increasing, the consumers for the same are increasing as well. There are various estimates about the size of the diabetes population but the one thing that company leaders agree on, is the fact that there will be a steady rise in diabetics. "According to MAT 2006, the diabetes market is estimated to be around Rs 1,236 crore with a 16 percent growth rate. As against this, the global market is estimated to be $18.6 billion (as per 2005 figures) with growth of 11.5 percent," reveals D'Souza.

For all those who say that Indians are very sweet is proving to be true in terms of the diabetic instances. There is high adult prevalence rate of diabetes in urban India. "The country is also characterised by earlier occurrence between the age group of 40 and 45 years versus other countries (beyond 55 years)," explains Gupta. Additionally, the country is also characterised by higher genetic pre-disposition (per studies conducted on Asian-Indians in US and UK), increasing income levels and urbanisation with attendant mix in diet quantity and composition, lifestyle changes (increasing proportion of sedentary workers) and an increasing proportion of population in higher age groups. "Today four to five percent of all diagnosed diabetics in India are Type 1 and around 95 percent are Type 2 diabetics," claims Gupta.

Though estimates speak of some numbers, there is yet another angle to this disease which is the naïve patient pool making this a segment with large untapped potential. "It is estimated that India has 32-33 million people with diabetes. However, patients under medical treatment would be only close to 1.1 million," says D'Souza.

Creating awareness

Another characteristic of the country is the fact that there is a need for awareness creation amongst the general populace regarding diabetes and the use of various diagnostic kits, insurance products and health programmes. With a view to reach the masses, companies like Roche Diagnostics and ICICI Prudential Life Insurance are trying to reach their target audience via mass media like the television. "Since there is no known cure for diabetes, good understanding of the disease and its effective management through active involvement of the patient and the health care professional is necessary. Thus, awareness plays a very crucial role in controlling the disease and leading a normal life," says Gupta. ICICI Prudential Life Insurance has launched a TVC, wherein a diabetic patient sees jalebis everywhere. The jingle starts, "mooh mein paani hai bana, par meetha khaana hai mana". The man with a sweet tooth even sees a child playing with jalebis. The jingle continues, "It's your problem, who cares"? The voice over states "We care" and explains about 'Diabetes Care' to be the first health insurance plan for diabetics. The ad ends with the protagonist ordering a tomato soup without any worries. This ad tries to convey the message that while nobody else may care if you have diabetes, ICICI Prudential does and hence it has launched a product to cater to your needs. Roche Diagnostics has roped in famous cricketer Wasim Akram as the brand ambassador for the Accu-Check diagnostic kits and has also come up with initiatives wherein patients can get an opportunity to interact with him.

Few years later…

The Indian diabetes market is slated to grow big as awareness of the disease increases. Impact on each of the growth drivers will influence the growth. "Today India is addressed as the diabetes capital of the world with 35 million people with diabetes which accounts for almost 20 percent of the world's diabetic population. And more than 30 percent of this population is under the age of 40," declares Gupta. It further projects an increase in the incidence of diabetes in the Indian population to 80 million by 2030 from the current levels," he adds. This may translate into a major public health problem due to the ever increasing economic burden that grows with this epidemic. Comprehensive diabetes management will therefore become important to prevent cost-intensive complications and to reduce the suffering of people affected.

As a result, companies which invest in running several education campaigns and activities that will influence the market growth. "Also, flourishing corporate hospitals, medical education, increased awareness and inclination towards better health will result in healthy growth for the diabetes market," opines D'Souza. In the future there will be significant impact on each of the growth drivers of the market. "A number of patients being diagnosed and under medical treatment is going to increase. The market is going to grow and penetration of insulin (insulinisation) is expected to increase further and a shift from OAD therapy to insulin products is expected to be on rise," he adds.

The burgeoning diabetic population is not just an indicator of a good market for many pharma companies, but also for those in other industries. Over the years, as awareness levels increase, more and more patients will go in for various services that will help them manage the disease better. Keeping this in mind, companies from and outside the pharma are joining forces and investing in education and awareness programmes to secure a big chunk of this sweet pie, once it gets baked.