Global Diabetes Treatment: One Size Does Not Fit All
By: Erica Caveney, MD | November 14, 2014
Diabetes is undoubtedly a growing healthcare concern worldwide. In China alone, more 98.4 million people suffer from diabetes; in India, more than 65.1 million; and in the United States, more than 24.4 million. And behind those numbers lays an even more distressing find: four out of five people with diabetes worldwide live in countries classified by the World Bank as low- and middle-income.
This global healthcare crisis requires a global approach to developing treatments. The problem is that the biopharmaceutical industry too often treats all of these patients as if they are the same. But differences in their genetic make-up, environment, culture, diet, economic status, comorbidities and the way they engage with the medical community, makes them vastly different from a treatment standpoint.
Diabetes researchers needs to start thinking about these patient populations in a more holistic way, factoring the differences among them into the way we pursue drug development paths, run clinical trials and capture real-world data around the way patient behavior impacts treatment results.
Such a targeted approach could help us identify critical markers that are unique to sub-populations, and enable us to create treatments that have a profound effect on specific patient groups. While this targeted approach may shrink the population of patients for a single treatment, it could deliver a competitive advantage over other treatment options in countries where the number of people living with diabetes is in the tens of millions.
We can look to successes in the oncology treatment sector for roadmaps to follow. Oncologists don’t treat every lung cancer or breast cancer as if it were the same thing. They have a wide array of chemotherapeutics to choose from, and they rely on genetic testing to figure out which is most likely to be successful for that that individual patient.
Admittedly, there are differences between the two diseases. With cancer, improvements in treatment options link directly to increased survival rates, whereas improvements in diabetes treatments are more often linked to improved quality of life. The genetics in cancer treatment are also easier to tease out and implement into more targeted therapies.
However, there are lessons to be learned from the history of oncology treatment as we head in this direction with diabetes care. If we can identify targeted therapies based on the unique genetic, environmental and culture aspects that impact the success of a diabetes treatment, we can improve the quality of life for millions of diabetes sufferers.
To do that, we need to conduct clinical research on a global scale, and parse out results based on regions. We need to explore what kinds of patients react to which class of drugs, and what those patients have in common. Such an approach may require more specific research than traditional trials, but in today’s over-crowded diabetes market, it is what is required for a drug to stand out for regulators, patients, providers and payers around the world.