India faces a significant diabetes burden, with some observers even labelling the country ‘The Diabetes Capital of the World’. Around 101.4 million adults, or 11 percent of the Indian population, have diabetes.


As Dr Brij Mohan, president of India’s Diabetes & Obesity Centre surmises, Indians tend to develop diabetes a decade earlier than their Western counterparts leading to a longer duration of living with the condition and increased risks of complications. Moreover, over half of individuals with diabetes remain undiagnosed, half of those who are diagnosed do not receive treatment, only half of those receiving treatment receive optimal treatment, and only half of them achieve targets. All of this has led to the proportion of well-controlled diabetes patients standing at a lowly 13-15 percent of the diabetic population. Urbanisation as well as lifestyle factors like dietary changes, physical inactivity, and increased body weight have all played their part in this alarming rise and 16 percent of the Indian urban population has diabetes (compared to eight percent in rural areas).

“Over the last two decades, diabetes prevalence in India has witnessed a steady increase, due to genetic factors, environmental influences, and the interplay of epigenetics,” says Vikrant Shrotiya, corporate vice president and managing director for Novo Nordisk, the Danish company whose oral semaglutide-based diabetes and obesity drugs have caused a media frenzy and soaring profits in recent years.

“This diabetes ‘tsunami’ is characterised by an alarming rise in early-onset cases, with individuals being affected at younger ages,” continues Shrotiya. “The demographic challenges in India amplify the complexities, particularly in rural areas where awareness, detection, and treatment accessibility pose significant hurdles. While urban centres benefit from better healthcare infrastructure, most of the Indian population resides in rural areas, making widespread awareness and detection paramount.”

The challenge extends beyond treatment pathways to insulin utilisation. “Only a fraction of the diabetic population in India is currently taking insulin, highlighting the need for early insulinisation, he adds. “The absence of a centralised access system places treatment decisions in the hands of individual clinicians, contributing to delays in insulin initiation.”


Moving the Dial

Tackling this health crisis in a large and diverse country like India is, in Dr Mohan’s words, “a complex and ongoing process.” The dial is, however, slowly moving. “Efforts are underway through various initiatives, including a program for universal screening for diabetes at healthcare centres, ensuring that individuals have access to early detection and care,” he states.

“The Ayushman Bharat program has also been implemented, providing free healthcare services, especially in remote areas where accessibility is challenging. Various organisations, including societies like ours, are actively involved in reaching out to different regions. We have a presence in 900-plus districts, with our efforts currently concentrated on training local healthcare workers, paramedics, and multipurpose healthcare staff to enhance awareness and facilitate screenings.”

Local pharma companies have a significant role to play in addressing the diabetes pandemic, as Dr Mohan notes. “India’s advantage lies in being a pharmaceutical manufacturing hub, producing medications at significantly lower costs than other countries. For instance, India manufactures one-third of the global requirement for Metformin, the primary drug used to treat diabetes.”


Global Pharma: Custom Strategies Needed

There is also space for global pharma to impact diabetes patients in India although the particularities of the local market mean that customised strategies are vital.

Suresh Pattathil, managing director and general manager at AbbVie, emphasises the value that even established products can have, given the scale of diabetes in India. “Despite being termed ‘established,’ these portfolios in areas like diabetes and age-related conditions are essentially growth portfolios due to the substantial patient population. For instance, with 100 million people in India suffering from diabetes, conditions like diabetic macular oedema become crucial to address.”

Over at Merck Healthcare, General Manager Pratima Reddy notes that “lifestyle-driven diseases, notably hypertension and diabetes, are widespread in India. While innovative portfolios can encounter higher price barriers, we are emphasising a combination of differentiation through a carefully curated selection of innovative products and driving access-related initiatives for patients.”

For those companies with diabetes products at the more innovative and high-value end of the spectrum, stakeholder engagement is the name of the game. As Novo Nordisk’s Shrotiya outlines, “Navigating a non-reimbursement market in India, where only five to seven percent of the population receives reimbursement for medications, demands a strategic approach. Novo Nordisk has successfully launched diabetes and obesity products, including oral semaglutide, employing several key strategies.”

He expands, “Firstly, conducting clinical trials in India has been pivotal. This approach not only provides doctors with hands-on experience during the research phase but also strengthens their conviction and faith in the product. The first-hand knowledge gained through clinical trials contributes to a deeper understanding and trust in the efficacy of the medication.”

“Secondly, Novo Nordisk focuses on pre-launch engagement, emphasizing scientific communication, innovation, and the value of control. By involving healthcare professionals in discussions about the science behind the product, its innovative aspects, and the clinical benefits, the company establishes a strong foundation for adoption. This collaborative approach ensures that healthcare professionals become advocates for the medication.”

AbbVie’s Pattathil agrees, foregrounding the importance of ‘market shaping’ to communicate new therapies’ true value. “The key lies in presenting a compelling case for optimal investments that go beyond mere coverage and actively contribute to shaping the market,” he says. “At AbbVie, we focus on patient-centric strategies that extend beyond typical approaches. In diabetic macular oedema, we concentrate on educating   the scientific community about treatment choices, especially the critical role of inflammation.”


The Power of Partnerships

Partnerships between multinationals and well-established local manufacturers could also provide better access to innovation and thereby a route out of India’s diabetes dilemma. “Strategic partnerships with Indian companies can extend access down the pyramid,” says Sampada Gosavi, general manager & managing director for Astellas Pharma. “The collaboration between multinationals and Indian companies, particularly in diabetes, heart failure, and hypertension, is gaining prominence. These partnerships enable multinationals to access a broader patient base, while Indian companies benefit from innovative products, thereby enhancing the overall innovation quotient.”

AbbVie’s Pattathil is similarly effusive on the power of partnerships. “In the pursuit of efficient business models, global pharma is exploring partnerships with other companies, often larger Indian players, to optimize resources,” he says. “These collaborations aim to manage established portfolios effectively, allowing global pharma to concentrate on core assets and more innovative priorities. For instance, there have been partnerships around diabetes, where global pharmaceutical companies collaborate with local Indian counterparts to extend the reach of new molecules to a broader network of primary care physicians.”