Printer Friendly Printed from http://www.researchandmarkets.com/reports/74365 Stakeholder Insight: Insulin Use in Type 2 Diabetes - From Last Resort to Early Intervention Description: Only 13-28% of drug-treated type 2 diabetes patients receive insulin therapy. The late initiation of insulin reflects the general trend that it is a last resort therapy in the treatment of type 2 diabetes. We believe that there will be a shift towards earlier initiation of insulin in the future, along with increased uptake, following the introduction of non-injected insulin. Scope Analysis of interviews with 388 physicians in the 7 major markets, validated via in-depth interviews with international experts Determination of the prevalence of type 1 and type 2 diabetes, with forecasts to 2012 Analysis of the use of insulin therapy in the treatment of type 2 diabetes by line of therapy and evaluation of early vs. late initiation of insulin Assessment of the potential patient population for non-injected insulin: evaluation of switch from injected insulin and add-on to OAD therapy Highlights Due to rising rates of obesity and the aging population, type 2 diabetes is an emerging epidemic: We estimate there will be 50.1m diabetics in the seven major markets in 2012. Despite the large patient population, Our physician research reveals that only 50% of type 2 diabetics across the seven major markets are diagnosed. The late initiation of insulin reflects the trend that insulin is a therapy of last resort in the treatment of type 2 diabetes. Although some experts believe that the earlier initiation of insulin is emerging, additional clinical trials are required to support this strategy. Non-injected insulins are expected to overcome the key unmet need in the insulin market by providing a more convenient mode of administration, and they are also expected to increase the overall use of insulin in type 2 diabetes patients and shorten the time to initiation. Reasons to Purchase Understand the factors limiting the use of insulin in type 2 diabetes, based on both physician and patient perception Validate product forecasting based on diagnosis and treatment rates, and the estimated future use of insulin in the treatment of type 2 diabetes Recognize lucrative target populations, in terms of unmet need and patient potential, in order to successfully position developmental products Contents: TABLE OF CONTENTS CHAPTER 1 EXECUTIVE SUMMARY 4 Scope of the analysis 4 Datamonitor insight into the type 2 diabetes insulin market 5 Summary 12 Key metrics 13 CHAPTER 2 INTRODUCTION AND SCOPE 23 Coverage of the Stakeholder Insight Survey 23 CHAPTER 3 COUNTRY TREATMENT TREES 26 Introduction to the treatment trees 26 US 27 Japan 29 France 31 Germany 33 Italy 35 Spain 37 UK 39 CHAPTER 4 DISEASE DEFINITION AND EPIDEMIOLOGY 41 Definition of type 2 diabetes 41 Etiology of type 2 diabetes 41 Complications of type 2 diabetes 42 Nephropathy 42 Retinopathy 43 Neuropathy 43 Macrovascular complications 44 Epidemiology of type 1 and type 2 diabetes 44 Current prevalence of type 1 and type 2 diabetes 44 Methodology 45 Future prevalence of type 2 diabetes 46 Methodology 47 CHAPTER 5 DIAGNOSIS AND TREATMENT RATES 49 Diagnosis 49 Symptoms and diagnosis 49 Diagnosis rates 51 Who manages patients with type 2 diabetes? 53 Treatment options 55 Existing therapy for type 2 diabetes 55 History of insulin 56 Treatment rates 57 Treatment guidelines for type 2 diabetes 60 Clinical practice guidelines from the ADA 60 The AACE system of Intensive Diabetes Self-Management 62 Physician and patient understanding of treatment guidelines 62 CHAPTER 6 INSULIN PRESCRIBING TRENDS 64 Indications for insulin use in type 2 diabetes 64 Overall use of insulin in type 2 diabetes 66 Current prescribing of insulin in type 2 diabetes 67 Change in insulin prescribing over the last three years 70 Guidelines advocating more aggressive treatment of type 2 diabetes 71 Analysis of past changes by physician type 73 Change in the prescribing of insulin over the next three years 74 Analysis of future changes by physician type 76 Reasons for and against insulin use in type 2 diabetes 80 Factors driving the use of insulin in type 2 diabetes 80 Improvement of glycemic control 80 Factors limiting the use of insulin in type 2 diabetes 82 Risk of hypoglycemia 83 Patient compliance with subcutaneous injections 88 Cost and reimbursement issues 92 Possible weight gain 96 Other barriers: attitude of the healthcare professional towards the use of insulin in type 2 diabetes 101 Other barriers: self-monitoring of blood glucose (SMBG) 103 Other barriers: incidence of heart failure increased in insulin-treated patients 109 CHAPTER 7 BREAKDOWN OF INSULIN THERAPY 111 Overview of line of therapy in type 2 diabetes 112 Breakdown by line of therapy 112 Monotherapy versus combination therapy 113 Breakdown of insulin use by line of therapy 115 Overview of insulin use by line of therapy 115 Approved insulin combinations 116 Breakdown of insulin prescribing at first line by physician type 117 Breakdown of insulin prescribing at second line by physician type 119 Second-line monotherapy 119 Second-line combination therapy 121 Breakdown of insulin prescribing at third line and beyond by physician type 125 Third-line monotherapy 125 Third-line combination therapy 126 Analysis of early versus late initiation of insulin 128 When is insulin therapy currently initiated in type 2 diabetics? 128 Number of years from diagnosis to initiation of insulin 128 Number of OADs prescribed before insulin is initiated 129 Clinical evidence supporting early initiation of insulin 129 Breakdown of insulin use by type and brand 131 Breakdown of insulin use by insulin type 134 Past and future changes in the use of different insulin types 137 Breakdown of insulin use by brand 148 Aventis’s Lantus – benefiting from its more predictable glycemic control 149 Eli Lilly’s Humalog – experiencing increasing uptake 152 Novo Nordisk’s NovoLog/NovoRapid – retaining strong growth 153 CHAPTER 8 POTENTIAL FOR NON-INJECTED INSULINS 155 Overview of the non-injected insulin pipeline 155 Inhaled insulin 156 Exubera – the most advanced non-injected insulin 158 Improving glycemic control in patients failing on combination OAD therapy 159 Exubera versus rosiglitazone in patients uncontrolled on diet and exercise 159 Success of Exubera will predict future of inhaled insulin 159 AERx iDMS – improving patient compliance 160 Inhaled insulin via AERx iDMS versus subcutaneous insulin injection 160 Technosphere Insulin – marketing partner required 162 AIR insulin – lack of financial support from Eli Lilly 163 Phase I inhaled insulin projects 164 Oral insulin 165 Oralin – termination of agreement with Eli Lilly 166 Emisphere oral insulin – seeking a partner to further development 167 HIM2 – further investigation in type 2 diabetes patients required 168 Macrulin – continued development uncertain 169 Barriers for non-injected insulin 169 Comparable efficacy and safety 170 Improved patient compliance 171 Reproducibility and accuracy of dosing 172 Switching patients from injected to non-injected insulin 173 Competitive pricing 174 Patient potential for non-injected insulin 175 Switch from injected insulin or OAD therapy 176 Add-on to existing OAD therapy 177 Will non-injected insulin result in the earlier initiation of insulin? 179 CHAPTER 9 OPINION LEADER AND STAKEHOLDER TRANSCRIPTS 181 Prof Burden 182 Treatment guidelines 182 Initiation of insulin in type 2 diabetes 184 Self-monitoring blood glucose (SMBG) 188 Choice of insulin therapy 190 The advent of non-injected insulins 191 Prof Fonseca 193 Treatment guidelines 193 Initiation of insulin in type 2 diabetes 193 Self-monitoring blood glucose (SMBG) 195 Choice of insulin therapy 196 The advent of non-injected insulins 198 David McAughey 199 Treatment guidelines and patient awareness 199 Initiation of insulin in type 2 diabetes 203 Self-monitoring blood glucose (SMBG) 207 The advent of non-injected insulins 209 Emma Bunn 211 Treatment guidelines and patient awareness 211 Initiation of insulin in type 2 diabetes 214 Self-monitoring blood glucose (SMBG) 217 The advent of non-injected insulins 219 APPENDIX A BIBLIOGRAPHY 221 Epidemiology 221 General bibliography 222 APPENDIX B 226 Physician research methodology 226 Physician sample breakdown 226 US 226 Japan 227 France 227 Germany 228 Italy 228 Spain 229 UK 229 Type 2 diabetes Insight survey questionnaire 231 Section 1: Physician perceptions of patient segmentation 231 Section 2: Treatment patterns in first-, second- and third-line therapy 232 Section 3: Key branded products 234 Section 5: Prescribing trends 234 Section 7: Insulin therapy in type 2 patients 235 Disclaimer 238 Ordering: Order Online - visit http://www.researchandmarkets.com/reports/74365 Order by Fax - using the order form below Order By Post - print the order form below and send to Research and Markets, Guinness Centre, Taylors Lane, Dublin 8, Ireland. 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