Diabetes & Insulin-User Predictions

Part
01
of three
Part
01

Projections, Number of People Using Insulin (US & Europe)

As there is no pre-compiled information on projections as it relates to insulin users specifically, we utilized data from WHO (World Health Organization), ADA (American Diabeties Association), CDC (Center for Disease Control), and the Department of Global Health. Projections and methodologies are below as they pertain to each geographical region. Further, I have included a Google spreadsheet with all necessary calculations and projections for reference. Please note: there is no consistent or recorded distinction between diabetics who classify as type 1 or type 2, so the numbers below are inclusive of all classifications of diabetes.

THE UNITED STATES

Please note. The most recent, holistic projections for diabetes in the United States is from 2015, as reported by the ADA, so all subsequent projections have been based off of this, and are in the attached spreadsheet. Further, the CDC confirmed that 23.8 million people in the United States in 2017 had diabetes, which is consistent with the ADA's projections in 2015 of roughly 1.4 million new cases of diabetes each year.

New cases each year, as predicted by the ADA: 1.4 million
Number of Americans who use insulin: 6 million

Looking at the data reported in 2015 (21 million diabetics), and the report that 6 million of those diabetics use insulin (either with or without other medications), we can determine that 29% of diabetics in the United States use insulin (6,000,000/21,000,000 = 29%).

Assuming the trend of an additional 1.4 million Americans each year diagnosed with diabetes, and taking into consideration that 29% of those Americans use insulin, we can predict that:

In 2023, there will be approximately 32.2 million Americans with diabetes, and 9.33 million of them will use insulin.

In 2028, there will be approximately 39.2 million Americans with diabetes, and 11.3 million of them will use insulin.

Please note — every year from 2015 to 2028 was calculated in the attached spreadsheet, with formulas included in each cell for reference.

EUROPE

As of 2014, as reported by the WHO, there were 60 million people in Europe with diabetes. Please note that the WHO classification of the European region includes over 50 countries, which have been included as a source for reference. By 2035, the WHO estimates that an additional 10 million Europeans will have been diagnosed with diabetes. Calculations were done using this projected additional 10 million, between the years of 2015 and 2035, for an average of 476,190 (10,000,000/21 = 467,190) additional cases of diabetes in Europe each year.

There was no insulin usage information as it pertains specifically to the European region. However, the Global Department of Health performed a study on the usage of insulin in April 2016, and concluded that the median usage of insulin among diabetics is 23.4%. This median percentage was used to calculate the projected amount of insulin users in Europe. Assuming a growth of 476,190 new diabetes cases a year, and 23.4% of all diabetics using insulin, we can project:

In 2023, there will be approximately 64.2 million Europeans with diabetes, and 15.04 million (64,200,000*0.234 = 15,040,000) insulin users.

In 2028, there will be approximately 66.6 million Europeans with diabetes, and 15.5 million insulin users.

Please note that every year from 2015 to 2028 was calculated in the attached spreadsheet, with formulas included in each cell for reference.

HOLISTICALLY

In 2023, there will be approximately 96.4 million people with diabetes in Europe and the United States, with 24.38 million projected insulin users. This is an average of 25% of all diabetics using insulin.

In 2028, there will be approximately 105.8 million people with diabetes in Europe and the United States, with 26.9million projected insulin users. This is an average of 25% of all diabetics using insulin.

SUMMARY

Utilizing projections from the ADA and CDC for the United States, and the WHO and Global Department of Health for Europe, we can project the total number of people estimated to be using insulin, in both Europe and the United States, to be 24.3 million in 2023 and 26.9 million in 2028. The attached spreadsheet has all necessary projections and calculations, with formulas included in each cell for reference.
Part
02
of three
Part
02

Projections, Number of People Using Insulin (China & India)

In China, the projected number of people that will be using insulin in 2023 and 2028 is 15,494,502 and 15,568,796 respectively. In India, the projected number of people that will be using insulin in 2023 and 2028 is 25,761,102 and 26,999,916 respectively. Below, you will find details on how we arrived at those projections.

CHINA

After an extensive search, we were unable to find any pre-compiled data on the projected number of people that will be using insulin in China in 2023 and 2028, so we had to estimate the number using available data.
Although we generally do not use sources older than two years, the latest data we could find on the percentage of the population in China with diabetes was from a 2013 study. According to the data, 10.9% of the Chinese population are diabetic (diagnosed and undiagnosed) and 4% of the Chinese population have diagnosed diabetes. Unfortunately, we were unable to find data on the percentage of the treated diabetic patients that use insulin in China specifically, so we relied on the global data that estimate that 27% of diabetics use insulin (14% of diabetics use only insulin and 13% use insulin and oral medication - 14% +13% = 27%).
We then used the above data and data on China's population projections in 2023 and 2028 to estimate the number of people using insulin in China:

2023 Projections

Total Population in 2023 = 1,434,676,116
Number living with diabetes = 1,434,676,116 * 10.9% = 156,379,697
Number diagnosed with diabetics = 1,434,676,116 * 4% = 57,387,045
Number of treated Using Insulin = 57,387,045 * 27% = 15,494,502
So in 2023, a projected 15,494,502 people will be using insulin.

2028 Projections

Total Population in 2028 = 1,441,555,143
Number living with diabetes = 1,441,555,143 * 10.9% = 157,129,510
Number diagnosed with diabetics = 1,441,555,143 * 4% = 57,662,206
Number of treated Using Insulin = 57,662,206 * 27% = 15,568,796
Hence, in 2028, a projected 15,568,796 people in China will be using insulin.

INDIA

After an extensive search, we were unable to find any pre-compiled data on the projected number of people that will be using insulin in India in 2023 and 2028, so we had to estimate the number using available data.
We found conflicting data on the number of people living with diabetes, so we decided to use the most reliable from a study published in an academic peer-reviewed journal in November 2015, the latest available. According to the study, based on WHO definition of diabetes, 5.9% of Indians in urban areas and 2.7% in rural areas were diabetic. This represents a total of 8.6% (5.9% + 2.7%) of Indians living with diabetes. Of the total living with diabetes, about 50% are undiagnosed. Among those diagnosed, the study found that 22% of diabetics in India received insulin, and an additional 19.8% received a combination of insulin and OHA. This means that a total of 41.8% received insulin (19.8% + 22%). We then combined those statistics with population projections for 2023 and 2028 to estimate the number of people that will be using insulin.

2023 PROJECTIONS

Total Population = 1,433,242,673
Number living with diabetes = 1,433,242,673 * 8.6% = 123,258,860
Number of diagnosed diabetics = 123,258,860 * 50% = 61,629,430
Number of treated Using Insulin = 61,629,430 * 41.8% = 25,761,102
Hence, an estimated 25,761,102 people in India will be using insulin in 2023.

2028 Projections

Total Population = 1,502,165,202
Number living with diabetes = 1,502,165,202 * 8.6% = 129,186,200
Number of diagnosed diabetics = 129,186,200 * 50% = 64,593,100
Number of treated Using Insulin = 64,593,100 * 41.8% = 26,999,916
Hence, an estimated 26,999,916 people in India will be using insulin in 2028.

CONCLUSION

To wrap up, the projected number of people in China that will be using insulin in 2023 and 2028 is 15,494,502 and 15,568,796 respectively, while the projected number of people in India that will be using insulin in 2023 and 2028 is 25,761,102 and 26,999,916 respectively.
Part
03
of three
Part
03

Predicted Trends in Diabetes Care (Mature vs. Developing Markets)

Mature market regions in developed countries, such as the United States, are quickly innovating new technology for the treatment of diabetes by heavily investing in R&D at major universities. Digital health trends are emerging such as automation of body functions, automation body parts, and gamification to treat diabetes. However, in developing markets, the diabetes treatment trends for the next 5-10 years show a focus on low-tech, low-cost grassroots development, education, and disease prevention. The WHO estimates that over 422 million individuals are suffering from diabetes globally. Currently, one in eleven has the chronic disease. If left untreated, diabetes can result in loss of limbs, blindness, heart failure, and stroke. Type 1 diabetes happens when the body fails to produce the proper amount of insulin. Type 2 diabetes happens when a person’s body cannot properly use the insulin it produces. While type 2 diabetes can be prevented with healthy lifestyle choices, type 1 diabetes is still a medical challenge that medicine is attempting to understand and solve. The way this challenge is being met largely depends on whether a region is in a developing market such as China, India, or Sub-Saharan Africa, or a mature market such as the United States and Europe.

THE STATE OF DIABETES IN THE DEVELOPING WORLD

In developing regions, diabetes is quickly becoming a major epidemic. Recently, the World Economic Forum declared diabetes as “the fastest growing disease of the poor.” Until a few years ago, international development organizations, foreign governments, and national medical bodies did not consider diabetes as a major public health concern. Other crises’ such as AIDS, Malaria, tuberculosis, and disease outbreaks were more of a focus. Now, this view has changed. Currently, 400 million people suffer from diabetes around the globe. Three hundred million of these individuals, or nearly 75%, live in developing countries. In 2013, China and India had the highest number of population with diabetes. In Sub-Saharan Africa and other developing countries, access to healthcare is extremely limited and living circumstances are poor. In general, there is a lack of heath care providers with needed expertise to properly care for patients with diabetes. Additionally, there is a scarcity of monitoring and diagnostic equipment and lack of adequate, uninterrupted insulin supplies. In some Asian and African developing countries, over 80% of people depend on “traditional” or complementary and medicine (CAM) for primary health care. CAM therapies are often used to treat diabetes with varying results that can be dangerous and ineffective. They are not part of the conventional healthcare system. CAM is commonly used among Asians, Indians, Latin Americans, and West Africa and its use is increasing between 20% to 80% every year.

DIABETES TREATMENT IN DEVELOPING MARKETS

Developing countries face special obstacles in successfully treating diabetes, including lack of information, scarcity of population-specific guidelines, and extreme disparities in public and private healthcare. To address these unsatisfactory trends while combating the disease, healthcare providers are focusing on “contextualized strategies” for diabetes prevention, diagnosis, management, and care. Since financing is a major treatment obstacle in developing countries, many of these strategies are also simpler and are not as heavily reliant on research and development (R&D) as in mature markets. Treatment strategies include:

1. Education on suitable footwear and foot care to prevent diabetes. 2. Implementing policy mandates for community education on healthy lifestyles, and heightening awareness of funding needs among local government agencies. 3. Training — The World Health Organization (WHO) recommends training for healthcare providers in developing countries to deliver basic diabetes care, train patients on home monitoring, provide foot care to stop amputations, offer eye screenings to avoid blindness, and give special education to pregnant women with diabetes to prevent additional complications. The World Diabetes Foundation has a database of dozens of diabetes treatment projects currently happening in developing regions. No matter how extensive these treatment projects are in developing countries, they are still grassroots based and not as technology based compared to treatment trends in Mature Regions.

THE STATE OF DIABETES IN MATURE REGIONS

Mature regions have been familiar with diabetes for some time, and are developing innovative strategies to treat it. Trends within the next five years point to unprecedented technological breakthroughs within the next five to ten years. Diabetes treatment is often technologically dependent. Technology is able to help with monitoring blood levels, glucose levels, weight levels, meal plans, and the periodic testing that is needed for successful diabetes management. Several digital health trends have emerged for treating diabetes patients in mature regions. This technology has been continuously improving, and innovation in this area is set to significantly transform in the next few years. Several diabetes treatment trends emerging in mature regions include: 1. Automation of the Body Daily management of diabetes normally requires continually monitoring blood glucose levels, injecting insulting, and keeping track of diet. Harvard University is utilizing two decades of research to automate this process through breakthrough technology such as an artificial pancreas. Frank Doyle, Dean of Harvard University’s school of engineering, predicts that within five years, “a fully automated system for diabetes will exist.” He believes this automation will happen as a result of “upgrades to devices biomedical companies already offer.” This model will be computational, mathematical, and a patient model — all reliant on automation. Engineers at MIT have figured out a way to create a substance that automatically hides healthy cells from the immune attacks that are common for type-1 diabetics.

Boston University has created a glucose-monitoring device that automatically delivers insulin, thus acting as an “artificial pancreas.” The FDA approved this pancreas for patients over age 14 in September 2016. It delivers additionally insulin to the body every five minutes, deciphering the exact amount the body needs. With the FDA approval, faster delivery and adoption of these types of automation devices for glucose control in diabetes treatment is expected to expand rapidly. 2. Gamification Companies such as MySugr are releasing diabetes management games and apps to make treatment more fun and engaging. Such products help patients engage more with their treatment and enables parents monitor their children’s therapy even when they are not around. 3. Body Enhancement

The University of North Carolina and NC State are working to eliminate the need for insulin injections and glucose monitoring. They have engineered “artificial beta cells” that mirror the way the body release insulin in healthy cells.

CONCLUSION

To wrap it up, there is an immense gap between how developing regions and mature regions are treating diabetes. Hi-tech trends in innovation that have high R&D cost such as automation of body functions, artificial pancreases, gamification, and cure automation are going to continue to increase over the next five to ten years. Developing regions will be focused on advancing diabetes education and basic disease prevention in light of existing challenges and limited budgets.
Sources
Sources