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Depth perception: diabetes in India

Using digital, pharma can engage with diabetes patients in India and build a 3D image of their needs

Depth Perception 

The world is being gripped by a diabetes epidemic with one in 10 adults worldwide suffering from the disease, which is a major cause of premature death. Globally, India is estimated to have the highest incidence of diabetes with 50.8 million people living with the condition: China is catching up with 43.2 million. Both countries have outpaced the US in incidence of diabetes to become joint 'diabetes capitals' of the world. This trend is expected to continue, with India and China making up nearly 50 per cent of the worldwide diabetes population by 2030. 

In high-income countries like the US, 85-95 per cent of all diabetes patients have type 2 diabetes. The percentage is even higher in countries like China and India, with record prevalence of type 2 predicted for 2030; 101 million in India, 130 million in China versus 30 million in the US, according to the International Diabetes Federation's Diabetes Atlas 5th Edition.

Like China, where a mere 3.05 per cent of patients actually report having type 2 diabetes, and only a third (even in urban areas of the country) are diagnosed (far fewer than the average of just less than 50 per cent in the rest of the emerging markets), prevalence figures in India are slightly skewed because the disease often goes undiscovered. 

One-third of Indian patients were diagnosed 'by accident', according to D-Picture, 2012 – a 360 degree research programme to understand type 2 diabetes patients in India, looking at demographic trends, symptoms, diagnosis, treatment and disease monitoring processes and involving 1434 patients across 15 Indian cities (including Mumbai and Delhi) and tier one towns (eg, Jaipur, Hyderabad, Lucknow, Cochin.

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Family history also has a part to play … or does it? Unlike diabetes hot spots like China and the US – where risk factors are often hereditary – almost two-thirds of the Indian patients Kantar Health spoke to who had developed diabetes did not have a family history of the disease. Although this discrepancy could be attributed to the lack of formal records, this is unlikely to be the case – were it so you would also expect to see similar trends in patients in rural areas in China.

Cost and treatment coverage
Cost of care is a potential issue in India and is impacting both diagnosis and treatment. Around 50 per cent of our sample were either employed or self–employed, and just 7 per cent had employer-related insurance to cover their treatment. Medical insurance penetration in India is generally low, even among more affluent patients, and diseases such as diabetes are often not covered by insurance policies. The region also suffers from a lack of investment in treatments: less than 1 per cent of worldwide diabetes spending is spent  in India compared with the US, which accounts for over half of worldwide diabetes expenditure. 

Medical insurance penetration in India is generally low, even among affluent patients

As well as putting pressure on healthcare expenditure, the economic burden – lost productivity and economic growth – of diabetes looms large, with the greatest burden being the costs associated with disability and loss of life as a result of the disease and its complications.

The World Health Organisation (WHO) predicted net losses in national income from diabetes and cardiovascular disease of Int$557.7bn in China and Int$336.6bn in India between 2005 and 2015. In India around 70 per cent of type 2 diabetes patients were diagnosed when they were under 50 years-old, suggesting that their working life was likely to be cut short. 

Poor disease awareness
Alongside affordability and the lack of treatment funding, poor awareness of the disease is impacting the treatment pathway. Type 2 diabetes can remain undetected for many years, and diagnosis often results from associated complications or accidently as the result of an abnormal blood or urine glucose test. 

A recent social media study conducted among diabetes patients in China found they take their disease seriously, with over three-quarters going online to discuss the pros and cons of therapies, diet and lifestyle. However, it seems that Indian patients do not have the same approach. Only one-third of our Indian sample could correctly identify the type of diabetes they have, and 93 per cent were not aware of their BMI. Although 50 per cent of the Indian sample was overweight (compared with a whopping 90 per cent in the US and 41 per cent in China) and recognised weight as a contributing factor in their disease state, they blame stress as being the main cause. 

Patients in China and the US are actively seeking out solutions and educational help for their diabetes. However, a traditional segmentation of patients in India revealed that 37 per cent fell into the 'careless and casual' category and another 18 per cent into the 'defiant non-followers' segment, meaning that over 50 per cent of our sample were in denial and/or lacked the discipline required to comply with prescribed treatment regimen. Three out of four had never had an HbA1c test and while most complied with doctor and specialist recommendations regarding frequency of diagnostic tests, doctor visits and brands purchased, around 64 per cent skipped doses. Most patients were not taking any corrective actions in terms of diet and lifestyle.

Engaging the non-engaged
These non-compliant patient groups should be targeted with marketing campaigns and messages that are different from those aimed at compliant patient segments. But how can pharma influence patients in India who don't want to comply or are in denial? 

In common with their counterparts from China and the US, diabetes patients in India are increasingly connecting with other patients using social media and other online communication tools. A random sample of 1,030 type 2 sufferers in urban India showed that 12 per cent go online at least once a week – a figure that is growing rapidly. Specialist community sites like D-book enable patients not only to share their experiences with fellow patients but to benefit from doctors' expertise using video conferencing and online discussion. 

… diabetes patients in India are increasingly connecting with other patients using social media …

Because wealthier Indian patients tend to have access to the internet, patient types in India were re-segmented using the Digital Life online classifications to determine the extent of stakeholders' activity and engagement online, and to see whether using mainly online communications would improve patients' engagement and compliance. 

Almost three-quarters of the sample have strong engagement in digital campaigns. Interestingly, over half of the Indian patient group, including non-compliant patients, fell into the 'aspirer' category with high online involvement. Therefore, they would be open to the use of social media and online chat for disease education and marketing even although they did not use these channels as much as some of the other groups. Another quarter of patients were power internet users or 'influencers'. 

Pharma companies looking to educate type 2 diabetes patients in India or encourage them to comply with a treatment regimen should explore how to get messages across digitally. It will also be particularly important to utilise available data to monitor changes in epidemiology, patient education and both health-related quality of life and economic outcomes across all the diabetes hotspots. While stopping the spread of the disease isn't possible, we can at least choose the best means to educate patients, help them come to terms with their disease, and help them manage their symptoms to achieve a better quality of life.


Diabetes prevalence (%) Adults aged 20-79 (in 1,000s) Adults with diabetes aged 20-79 (in 1,000s)
Africa 3.80 386,298 14,722
Europe 8.08 653,233 52,771
Middle East/North Africa 9.15 356,438 32,603
North America 11.72 321,968 37,737
South America 8.68 289,539 25,134
Southeast Asia 8.34 856,282 71,407
Western Pacific 8.54 1,544,462 131,896

Source: International Diabetes Federation 2012

Rank Country 2011 2030 2030 minus 2011
T2D Population* Prevalence (%) T2D Population* Prevalence (%) A T2D Population* A in T2D Prevalence
1 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%

* In millions
Source: International Diabetes Federation 2012

The Author
Reena Thapar is a research manager at Kantar Health. She can be contacted at reena.thapar@kantarhealth.com

23rd November 2012

From: Sales, Healthcare

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