Treatment Algorithms: Type 2 Diabetes – Novel Classes Drive Fragmentation of Treatment Choices in Type 2 Diabetes

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* Follow the patient segmentation and treatment pathways for type 2 diabetes in each market

* Compare drug use across all therapy lines and single/combination treatment strategies

* Identify opportunities to consolidate patient share in the widely fragmented diabetes treatment algorithm.

* Gain insight into physicians’ perceptions on trends in use of key antidiabetic classes.

Physicians estimate that a mean of 37% of people with type 2 diabetes in the seven major markets remain undiagnosed. Of the diagnosed patients, 16% are not being treated with drugs. Datamonitor estimates that the adult type 2 diabetes drug-treated population in the seven major markets is close to 27 million patients.

Physicians report 278 different class combinations used across first line, second line, and third and later line. Patient treatment varies with individual response, lifestyle, and comorbidities. However, the top 10 combinations account for 47% of all combination-treated patients, suggesting the use of common approaches in managing diabetes.

Type 2 diabetes patients are fairly evenly split between first-line, second-line, and third-line and later therapies. Specialist diabetologists and endocrinologists report more later-line patients compared with primary care physicians (PCPs). While 75% of treatment at first line is monotherapy, combinations dominate later-line treatment.

* Delve into primary data from 199 seven major market physicians on current usage and future trends of type 2 diabetes therapies.

* Follow through the most used monotherapies and combination therapies at each therapy line, in each market.

* Identify the different opportunities in the type 2 diabetes treatment algorithm in each of the seven major markets.

Executive Summary

OVERVIEW

Catalyst

Summary

COUNTRY PATIENT PROFILE TREES

Methodology

Overview of patient profiles in type 2 diabetes

Complications in type 2 diabetes

Comorbidities in type 2 diabetes

Seven major markets

US

UK

COUNTRY TREATMENT TREES

Methodology

Seven major markets

US

UK

Overview of treatment trees in type 2 diabetes

Patients are evenly spread among first-line, second-line, and later-line regimens

Monotherapies in type 2 diabetes

Combination therapies in type 2 diabetes

Therapy choice in type 2 diabetes

TYPE 2 DIABETES DEFINITION AND DIAGNOSIS

Disease definition

Segmentation of diabetes

Type 1 diabetes

Type 1.5 diabetes

Type 2 diabetes

Etiology of type 2 diabetes

Mechanisms of development of diabetes

Genetic or acquired causes

Risk factors and symptoms of type 2 diabetes

Risk factors and comorbidities

Symptoms

Prognosis

Diagnosis in type 2 diabetes

Over one third of patients are undiagnosed

Reasons for a low diagnosis rate

Screening can increase diagnosis rates

Managing physicians in type 2 diabetes

The majority of diabetics are diagnosed and managed by primary care practitioners

Physicians rank their own practice type as having higher involvement

TREATMENT OPTIONS IN TYPE 2 DIABETES

Pharmacological and non-pharmacological management of diabetes

Patient compliance with drug therapy

Use of monotherapy versus combination therapy

Most monotherapy takes place at first line

Therapy change in type 2 diabetes: 39% of patients have changed lines within a year

KEY CLASSES IN TYPE 2 DIABETES

Overview of available drug classes

Use of different classes in type 2 diabetes

Patient share of key drug classes: metformin dominates type 2 diabetes treatment

Trends in use of key antidiabetic classes: incretin mimetics growing strongly

Metformin

Metformin use will continue to rise

Metformin used as first-line monotherapy, combined with other drugs at later lines

Sulfonylureas

Alternatives lead to decrease in sulfonylurea use

Sulfonylureas can be used at all therapy lines

Key branded classes in type 2 diabetes

Pioglitazone

DPP-IV inhibitors

GLP-1 agonists

Insulins

Most physicians have increased the use of insulin in the past 3 years

Insulins used as a later-line therapy

Countries vary widely in their insulin use

Other classes

Alpha-glucosidase inhibitors

Prandial glucose regulators

SGLT-2 inhibitors

BIBLIOGRAPHY

Journal papers

Websites

Datamonitor reports

APPENDIX A

Datamonitor’s Type 2 Diabetes Physician Survey

APPENDIX B

Contributing experts

Report methodology

SOURCE Reportlinker