Stakeholder Opinions: Type 2 Diabetes in the UAE & Saudi Arabia Growth opportunities in fragmented markets

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.

Report 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.
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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 115
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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
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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