Table of Contents

Stakeholder Opinions: Type 2 Diabetes in the UAE & Saudi Arabia Growth opportunities in fragmented markets - Analysis of the UAE and Saudi Arabia, the two largest diabetes markets in the GCC, where unprecedented levels of prevalence of type 2 diabetes has been observed

Product Code: dmhc2480

Publication Date: 19-Dec-2008

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Overview

Introduction

This report focuses on the challenges of diverse and uncoordinated treatment paradigms for diabetes and the movement to rationalize efforts and establish best practice. Datamonitor uncovers the unique dynamics of the two largest diabetes markets in the GCC; including the impact of regulatory processes such as the healthcare reforms currently being undertaken.

Scope

· Description and analysis of the uniqueness of the antidiabetic markets in the UAE and Saudi Arabia

· Fragmented healthcare delivery in the UAE and Saudi Arabia presents opportunity for ramping up sales of generics and novel antidiabetic therapeutics.

· Commercial implications of Datamonitor's extensive findings and our recommendations to maximize sales in these two markets.

Highlights

Diabetes has reached near-epidemic proportions in the UAE and Saudi Arabia, with nearly one out of every five individuals suffering from diabetes in the UAE. In Saudi Arabia, the prevalence is expected to rise to between 40-50% by 2020.

The delivery of treatment for diabetes is highly fragmented, and leads to sub-optimal treatment for patients in the two countries. The fragmentation is caused by a wide variety of issues due to systemic deficiencies, regulatory changes and socio-economic factors.

Datamonitor has explained the commercial implications of its findings and developed recommendations for healthcare firms and regulators to address the many unmet needs in the treatment of diabetes and to ramp up sales and share of market in both UAE and Saudi Arabia.

Reasons to Purchase

· Gain an in-depth understanding of the two largest diabetes markets in the GCC; a strategic growth area for healthcare firms.

· Increase share of the market by effectively targeting the different segments of the population and demands; branded or generic antidiabetic agents.

· Maximize current and future revenue streams by targeting the numerous growth opportunities identified by Datamonitor.

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ABOUT DATAMONITOR HEALTHCARE	2
About the Cardiovascular pharmaceutical analysis team	2
CHAPTER 1 EXECUTIVE SUMMARY	4
Scope of the analysis	4
Datamonitor insight into type 2 diabetes in the UAE and Saudi Arabia	4
Related reports	5
Upcoming reports	5
Key Opinion Leaders Interviewed	6
CHAPTER 2 DEFINITION OF DIABETES AND DISEASE OVERVIEW	9
Definition of diabetes	9
Segmentation of diabetes	10
Type 1 diabetes	10
Type 2 diabetes	11
Etiology of diabetes	12
Mechanisms of development of diabetes	12
Genetic or acquired causes	12
Risk factors	13
Obesity	13
The type 2 diabetes epidemic goes hand-in-hand with the obesity epidemic.	13
Family history	15
Type 2 diabetes in first-degree relatives is a strong prognostic indicator	15
Advanced age	16
Diagnosis of type 2 diabetes may be overlooked in older patients	16
Gender	16
Risk of type 2 diabetes may be greater in females	16
History of prediabetes	17
Physical inactivity	18
Diet and western lifestyle	19
Arab and South Asian genetic susceptibility	20
Consanguinity and thalassemia minor are risk factors for diabetes.	21
Other factors	22
Socio-economic traditions	22
The role of alcohol and fasting blood glucose	23
Vitamin D deficiency and diabetes	23
Epidemiology	24
Increasing prevalence of diabetes in the GCC	25
Economic burden of diabetes	27
CHAPTER 3 DIAGNOSIS OF TYPE 2 DIABETES	29
Diagnosis of type 2 diabetes	29
Patient management	30
Management of diabetes should be done by a team, not just a specialist	30
Healthcare provision in Saudi Arabia is highly fragmented	32
Abu Dhabi and Dubai have excellent healthcare facilities, but the northern emirates are lagging behind.	32
Abu Dhabi	32
Dubai	33
The role of PCPs in type 2 diabetes management	34
Referral to specialist	35
Reasons for poor diagnosis	37
Insidious nature of the disease	37
Lack of screening	38
Awareness of guidelines	38
Strategies to increase diagnosis rates	39
Improving guideline awareness of PCPs	39
There is a need for a targeted screening program	39
Strategies to prevent diabetes	40
Preemptive treatment	40
Education in the UAE	40
Building awareness of diabetes in Saudi Arabia	41
CHAPTER 4 DIABETIC COMPLICATIONS	43
Complications of diabetes	43
Nephropathy	43
Effect of nephropathy on type 2 diabetes treatment	45
Retinopathy	45
Effect of retinopathy on type 2 diabetes treatment	46
Neuropathy	46
Effect of neuropathy on type 2 diabetes treatment	47
Macrovascular complications	47
Effect of macrovascular complications on type 2 diabetes treatment	48
Co-morbidities	49
Obesity	49
Effect of obesity on type 2 diabetes treatment	49
Hypertension	50
Dyslipidemia	50
CHAPTER 5 CURRENT TREATMENT OPTIONS FOR TYPE 2 DIABETES	52
International treatment guidelines for type 2 diabetes	52
Clinical practice guidelines from the ADA/EASD	52
The AACE-ACE clinical practice guidelines	55
Guideline use in the UAE and Saudi Arabia	59
Treatment patterns	62
Lifestyle management for type 2 diabetes	65
Pharmacological treatment	66
In Saudi Arabia, the new classes of antidiabetics are not yet approved and most branded drugs are not available in MOH primary care centers	66
KOLs in the UAE are very satisfied with the pharmacological options available for use	67
Insulin use in Saudi Arabia is limited by the types available to physicians	68
Alternative and adjunct therapies	70
Prescribing trends and influences	71
Slow approvals by the SFDA and the exlusion of drugs from MOH formularies hampers prescription in Saudi Arabia, while the latest drugs are available to physicians in the UAE.	73
Nationality influences the standard of care available	74
Self-management	77
CHAPTER 6 UNMET NEEDS	79
Limited availability of drugs	79
The need to build awareness of diabetes, obesity and healthy lifestyle	79
The need for diabetes education teams	80
Guideline awareness of PCPs	81
Patient compliance	82
CHAPTER 7 COMMERCIAL IMPLICATIONS OF FINDINGS AND RECOMMENDATIONS	83
GCC is a strategic growth region	83
Growth through partnerships with regional players	88
Dubai has created a favorable landscape for foreign healthcare investment	89
The antidiabetic markets in the UAE and Saudi Arabia are unique	90
The UAE is very receptive to new antidiabetic drugs and is brand-conscious	90
The Saudi Arabian market is plagued by slow approvals	91
Treatment paradigms are highly diverse in the UAE and Saudi Arabia	93
Use of different guidelines and poor adherence to them	93
Lack of access to newer antidiabetic therapies in Saudi Arabia	94
Insufficient insurance coverage impedes delivery of optimal treatment in the UAE	94
Domestic pharmaceutical sectors	95
The local pharmaceutical firms in UAE and Saudi Arabia are export-oriented	95
UAE	95
Saudi Arabia	96
Regulatory environments	97
The privatization of payment will favor generics in the long term	97
Slow approval procedures in Saudi Arabia	98
Guideline development is critical in both countries	98
Recommendations for local and regional generics pharmaceuticals	99
Recommendations for multinational pharmaceutical companies	100
Recommendations for healthcare regulators	102
APPENDIX	104
About Datamonitor	113
About Datamonitor Healthcare	113
About the Disease analysis team	114
Disclaimer	116
List of Tables
Table 1: Summary of differences between type 1 and type 2 diabetes	10
Table 2: Current prevalence of type 2 diabetes, GCC	26
Table 3: ADA evidence grading system for clinical practice guidelines	53
Table 4: AACE recommendations for type 2 diabetes patients naïve to pharmacotherapy	57
Table 5: AACE recommendations for type 2 diabetes patients currently on pharmacotherapy	58
List of Figures
Figure 1: Percentage of overweight adults aged 15 and over, GCC	14
Figure 2: Top 10 countries in prevalence of diabetes (20-79 age group)	24
Figure 3: Current prevalence of diabetes and forecasts for 2025	26
Figure 4: Treatment algorithm for type 2 diabetes, recommended by the 2006 ADA/EASD clinical practice guidelines	54
Figure 5: The proportion of diabetics in each GCC country	83
Figure 6: Population pyramid for Saudi Arabia: 2010	85
Figure 7: Population pyramid for Saudi Arabia: 2020	86
Figure 8: Population pyramid for UAE: 2010	87
Figure 9: Population pyramid for UAE: 2020	88
Figure 10: UAE pharmaceutical sector sales segmentation	90
Figure 11: Saudi pharmaceutical sales segmentation	92

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