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Diabetes, Metabolic Syndrome and Cardiovascular Disease

  • January 2016
  • -
  • TriMark Publications
  • -
  • 270 pages

There has been a dramatic increase in the incidence of diabetes worldwide, which has been exacerbated by the growing obesity problem across the globe. Once thought of as primarily a childhood disease--sometimes referred to as juvenile diabetes, now mostly Type 1 diabetes--the obesity crisis linked to the adoption of a high-fat, high-carbohydrate, high-calorie American diet has resulted in skyrocketing rates of diabetes among adults across the world. To compound the global diabetes epidemic, health professionals are witnessing an alarming increase in inflammatory diseases resulting from adult onset (i.e., Type 2) diabetes. This phenomenon is referred to as "metabolic syndrome" where a confluence of inflammatory conditions occur along with the diabetes. As a result, growing evidence appears to show that metabolic syndrome makes the diabetic patient susceptible to degenerative health conditions such as cardiovascular disease, stroke and, now believed, Alzheimer's disease. As the diabetes epidemic escalates, a new sense of urgency has taken hold. Proactive strategies for prevention of the disease are being put in place by international health organizations such as the World Health Organization (WHO), as well as by the health departments of industrialized and developing countries, and even at the local level where food ingredients regulations are being passed. This TriMark Publications report charts the changing landscape of the global diabetic population and explores the added health concerns resulting from the metabolic syndrome phenomenon and one of its major risk factors: cardiovascular disease (CVD). Furthermore, this study evaluates widely-accepted therapeutic approaches to diabetes that are currently in use, while providing an in-depth analysis of emerging technologies that will be used to treat diabetes and other inflammatory diseases in the future.

Table Of Contents

Diabetes, Metabolic Syndrome and Cardiovascular Disease










TABLE OF CONTENTS



1. Overview 9

1.1 Statement of Report 9

1.2 About this Report 9

1.3 Scope of the Report 10

1.4 Methodology 11

1.5 Executive Summary 12



2. Introduction 16

2.1 Demographics of Diabetes 17

2.1.1 Worldwide Diabetes 17

2.1.2 U.S. Diabetes 20

2.2 Economics of Diabetes 26

2.2.1 Worldwide Costs of Diabetes 26

2.2.2 Costs of Diabetes in the U.S. 27



3. Understanding Diabetes 32

3.1 Pre-Diabetes Syndrome 33

3.2 Metabolic Syndrome 33

3.2.1 Prevalence of Metabolic Syndrome 36

3.2.2 Management of Metabolic Syndrome 37

3.2.3 The Debate Regarding Metabolic Syndrome 37

3.3 Diabetes and Inflammation 38

3.4 Diagnosis of Diabetes Mellitus 39

3.5 Progression of Diabetes 39

3.6 Obesity and Diabetes 39

3.7 Complications and Co-Morbidities in Type 2 Diabetes 41

3.7.1 Preventing Complications and Co-Morbidities in Diabetes 45



4. Pharmaceutical Industry and the Anti-Diabetes Drug Market 47

4.1 The Worldwide Pharmaceutical Industry 47

4.1.1 Pharmaceutical Randamp;D Spending by Type, Growth Rate and Expenditure 47

4.1.2 Global Pharmaceutical Market 49

4.2 Overall Diabetes Drug Market Size and Growth 55

4.2.2 Sales Forecast for the Global Anti-diabetes Drug Market 59

4.3 Diabetic Medications Overview 61

4.3.1 Recent Trends in Diabetic Drug Usage 63

4.3.2 Market Influence Factors 65



5. Non-Insulin Anti-Diabetes Products and Market 67

5.1 Non-Insulin Anti-Diabetes Drug Market Drivers and Trends 70

5.1.1 Market Share and Forecast of Non-Insulin Anti-Diabetic Drugs 71

5.1.2 Latest Additions to the U.S. Non-Insulin Diabetes Drug Market 73

5.1.3 GLP-1 Market Revenue, Market Share, Key Players 73

5.1.4 DPP-4 Inhibitor Market Revenue, Market Share and Key Players 74

5.1.5 SGLT-2 Inhibitor Market Revenue, Market Share and Key Players 76

5.2 Sulfonylureas 76

5.3 Meglitinides 77

5.4 Biguanides 78

5.5 Thiazolidinediones (TZDs) 79

5.6 a-Glucosidase Inhibitors 81

5.7 Amylin Analog 82

5.8 GLP-1 (Glucagon-like Peptide) Analogs and Agonists/Incretin Mimetics 82

5.8.1 Byetta (Exenatide) 83

5.8.2 Bydureon (Exenatide LAR) 84

5.8.3 Victoza (Liraglutide) 84

5.8.4 Tanzeum (Albiglutide) 84

5.8.5 Trulicity (Dulaglutide) 85

5.9 DPP-IV Inhibitors 85

5.9.1 Januvia (Sitagliptin) 87

5.9.2 Onglyza (Saxagliptin) 87

5.9.3 Tradjenta (Linagliptin) 87

5.9.4 Galvus (Vildagliptin) 87

5.9.5 Nesina (Alogliptin) 88

5.9.6 Marizev (Omarigliptin) 88

5.10 SGLT-2 Inhibitors 88

5.10.1 Invokana (Canagliflozin) 89

5.10.2 Farxiga (Dapagliflozin) 89

5.10.3 Jardiance (Empagliflozin) 90

5.10.4 Suglat (Ipragliflozin) 91

5.10.5 Lusefi (Luseogliflozin) 91

5.11 Fixed Dose Combination Therapies on the Market 91

5.12 Antidiabetic Drug Options for Youth with Recent-Onset Type 2 Diabetes
Scarce 93

5.13 Comparisons of the Anti-Diabetes Drugs 93

5.14 Non-Insulin Anti-Diabetes Products in the Pipeline 94

5.14.1 Novel GLP-1 Agonists and Analogs 94

5.14.2 Novel DPP-IV Inhibitors 97

5.14.3 Sodium Glucose Cotransporter 2 (SGLT-2) Inhibitors 99

5.15 Emerging Anti-Diabetes Targets and Drugs in the Pipeline 100

5.16 Novel Approaches to Finding New Drug Targets 104



6. Insulin Markets 105

6.1 Major Players and Market Share in the Insulin Market 107

6.2 Patent Expirations 109

6.3 Insulin Biosimilars 109

6.3.1 Regulatory Avenues for Biosimilar Approval 110

6.3.2 Insulin Biosimilars on the Market 110

6.3.2.1 Abasaglar (formerly Abasria) and Basaglar 110

6.3.2.2 Other Biosimilars 110

6.3.2.3 Key Issues for Insulin Biosimilars 110

6.4 Innovation Strategies 111

6.5 Overview of Insulin Therapeutics on the Market 111

6.5.1 Recommendations for Insulin Initiation and Administration 113

6.6 Short-Acting Human Insulin Market 115

6.7 Rapid-Acting Insulin Analog Market 117

6.7.1 Ultra Fast-Acting Insulins in Development 118

6.8 Intermediate-Acting Insulin Market 120

6.9 Long-Acting Insulin Market 121

6.9.1 Lantus-Sanofi's Insulin Blockbuster 123

6.9.2 Toujeo-Sanofi's Bid to Maintain Insulin Market Share 124

6.9.3 Levemir Market 124

6.9.4 Tresiba Approved for the U.S. Market 125

6.9.5 Lantus Biosimilars 126

6.9.5.1 Abasaglar (formerly Abasria) and Basaglar 126

6.9.5.2 Other Biosimilars 126

6.10 Insulin Mixtures 127

6.11 Pipeline Insulins in Development 128

6.11.1 BIOD-531 (Biodel) 128

6.11.2 Xultophy (Novo Nordisk) 128

6.11.3 LixiLan (Sanofi) 128

6.11.4 rHUPH20 and Insulin (Halozyme) 128

6.11.5 FIAsp (Novo Nordisk) 129

6.11.6 BIOD-238, BIOD-250, and BIOD-351 (Biodel) 129

6.11.7 InsuPatch and InsuPad (Insuline Medical) 129

6.11.8 MK-1293 130

6.11.9 Smart Insulins 130

6.12 Non-Invasive Insulin Delivery 130

6.12.1 Inhaled Insulin 131

6.12.1.1 Afrezza 132

6.12.1.2 Dance Pharmaceuticals and Aerogen (Dance-501) 133

6.12.1.3 A Chronicle of Inhaled Insulins 134

6.12.2 Oral Insulin 135

6.12.3 Transdermal Insulin 138

6.13 Barriers for Non-Injected Insulin 139

6.14 Patient Potential for Non-Injected Insulin 140

6.15 Insulin Delivery Devices 140

6.15.1 Insulin Pens 142

6.15.2 Injections Aids 145

6.15.2.1 Automatic Injectors 146

6.15.2.2 Syringe Magnifiers 147

6.15.2.3 Injection Ports 147

6.15.3 Insulin Jet Injectors 148

6.15.4 Insulin Pumps 148

6.15.4.1 External Insulin Pumps 149

6.15.4.2 Animas OneTouch Ping 152

6.15.4.3 Animas Vibe 153

6.15.4.4 Accu-Chek Combo Insulin Pump System (Roche) 153

6.15.4.5 MiniMed Paradigm Real-Time Revel (Medtronic) 154

6.15.4.6 MiniMed 530G with Enlite (Medtronic) 154

6.15.4.7 Insulet Omnipod 154

6.15.4.8 DANA IIS (Sooil) 155

6.15.4.9 t:flex (Tandem Diabetes Care) 155

6.15.4.10 t:slim (Tandem Diabetes Care) 155

6.15.4.11 Snap (Asante) 155

6.15.5 Insulin Infusion Sets 156

6.15.6 Insulin Patch Pumps in Development or Only Available Outside the U.S. 157

6.15.7 Implantable Insulin Pumps 159

6.15.8 Insulin Pump Market Share 160

6.15.9 Drivers of Demand for Pumps 161

6.16 Market Forecasts for Insulin Administration Technologies 161



7. Emerging Anti-Diabetes Technologies and Products 162

7.1 Projections for the Anti-Diabetes Drug Market 162

7.2 Artificial Pancreas 166

7.2.1 MiniMed 530G System 167

7.2.2 Animas Vibe System 167

7.2.3 Next Generation Medtronic Artificial Pancreas Systems (MiniMed 640G) 167

7.2.4 FDA's Artificial Pancreas Guidance Document 168

7.3 Insulin-Producing Cells 168

7.3.1 Gene Therapy 169

7.3.2 Cell Therapy Companies for Diabetes 170

7.3.2.1 ViaCyte (formerly Novocell, Inc.) 170

7.3.2.2 Sernova 170

7.3.2.3 Semma Therapeutics 171

7.4 Pre-Mixed Glucagon for Self-Treating Hypoglycemia 171

7.5 Anti-Obesity Drugs to Prevent or Delay Development of Type 2 Diabetes 171

7.5.1 Xenical (Roche) 171

7.5.2 Qsymia (Vivus) 171

7.5.3 Belviq (Arena Pharmaceuticals) 171

7.5.4 Contrave (Orexigen Therapeutics) 172

7.5.5 Saxenda 172

7.5.6 Anti-Obesity Drugs in Development 172

7.6 Insulin and Anti-Diabetes Drug Combinations 172

7.6.1 Xultophy (Novo Nordisk) 172

7.6.2 LixiLan (Sanofi) 173



8. Market Trends, Challenges and Strategic Options 174

8.1 Overview 174

8.2 Diabetes Drug Market Trends 174

8.2.1 Overview 174

8.2.2 Emergence of Therapeutics with Improved Administration Characteristics 174

8.2.2.1 Barriers to the Initiation of Insulin Therapy in Type 2 Diabetics 176

8.2.3 Increasing Prevalence of Obesity 176

8.2.4 Consumer Preference Drives Product Development in Invasive Technology
Segment 177

8.3 Diabetes Mellitus Market Challenges 177

8.3.1 Overview 177

8.3.2 Patent Expirations 178

8.3.3 Market Prospects of Inhalable Insulin 178

8.4 Strategic Options 179

8.4.1 Developing Countries are Key Markets for Growth 180

8.4.2 Consumer-Driven Marketing Campaigns 181

8.4.3 Strategies for Successful New Product Launches 181

8.4.4 Collaborations and Strategic Alliances 182

8.5 FDA Guidelines for Developing Anti-Diabetic Drugs 183

8.6 Recent Industry Activity 183



9. Company Profiles 187

9.1 A. Menarini 187

9.2 Abbott Laboratories 187

9.3 Abbvie 191

9.4 Amgen 191

9.5 Amylin Pharmaceuticals (bought by Bristol-Myers Squibb) 192

9.6 Animas (part of Johnson andamp; Johnson) 192

9.7 Asante 192

9.8 Astellas Pharma, Inc. 192

9.9 AstraZeneca PLC 193

9.10 Bayer 194

9.11 Becton, Dickinson and Company 196

9.12 Biocon 197

9.13 Biodel 198

9.14 BodyMedia 198

9.15 Boehringer Ingelheim 198

9.16 Bristol Myers Squibb 199

9.17 Cellnovo 199

9.18 CeQur 199

9.19 ConjuChem 199

9.20 Daiichi Sankyo 200

9.21 Dance Biopharm 200

9.22 Debiotech 200

9.23 DexCom 200

9.24 Echo Therapeutics, Inc. 202

9.25 Eli Lilly 203

9.26 FIFTY50 Medical, Inc. 204

9.27 Flamel Technologies 204

9.28 Generex Biotechnology Corporation 204

9.29 GlaxoSmithKline PLC 205

9.30 Halozyme Therapeutics 205

9.31 Insulet 205

9.32 Insuline Medical Ltd. 206

9.33 Intarcia Therapeutics, Inc. 206

9.34 Janssen Research andamp; Development 206

9.35 Johnson andamp; Johnson 207

9.36 Kowa Pharmaceuticals 208

9.37 Lexicon Pharmaceuticals 208

9.38 MannKind Corporation 209

9.39 Medipacs 209

9.40 Medtronic 209

9.41 Merck andamp; Company, Inc. 210

9.42 Mitsubishi Tanabe Pharma Corporation 211

9.43 Novartis 211

9.44 Novo Nordisk 211

9.45 Oramed Pharmaceuticals 212

9.46 Orexigen Therapeutics, Inc. 212

9.47 Owen Mumford 213

9.48 PhaseBio Pharmaceuticals 213

9.49 Pfizer 213

9.50 Prometheon Pharma 214

9.51 Roche Diagnostics 214

9.52 Sanofi 216

9.53 Sernova 217

9.54 Smiths Medical 217

9.55 SOOIL Development 218

9.56 Taisho Pharmaceuticals 218

9.57 Takeda 218

9.58 Tandem Diabetes Care, Inc. 218

9.59 Theracos, Inc. 219

9.60 Transdermal Specialties, Inc. 219

9.61 Valeritas 219

9.62 ViaCyte, Inc. (formerly Novocell) 219

9.63 Vivus, Inc. 220

9.64 vTv Therapeutics (formerly TransTech Pharma) 220

9.65 Ypsomed Holding 220

9.66 Zealand Pharma 220





INDEX OF FIGURES



Figure 2.1: Worldwide Diabetes Cases, 2015 and 2035 17

Figure 2.2: Worldwide Prevalence of Diabetes (%) in Adults (20-79 Years), 2013
18

Figure 2.3: Annual Number of New Cases of Diagnosed Diabetes Among U.S. Adults
Aged 18-79 Years,

1980-2012 21

Figure 2.4: New Adult Cases of Diabetes Diagnosed in the U.S., 2012 22

Figure 2.5: Diagnosed and Undiagnosed Diabetes by Age in the U.S., 2013 22

Figure 2.6: Percentage of U.S. Adults Diagnosed Diabetes by State, 2013 24

Figure 2.7: Number of Deaths from Diabetes by Age in the U.S., 2013 25

Figure 2.8: Number of Diabetes Deaths by Race and Sex in the U.S., 2013 25

Figure 2.9: Mean Diabetes Healthcare-Related Expenditures Per Adult (20-79
Years) with Diabetes (USD),

2013 26

Figure 2.10: How Diabetes Dollars are Spent in the U.S. 28

Figure 3.1: Maintenance of Normal Blood Sugar Levels 32

Figure 3.2: Prevalence of Self-Reported Obesity (BMI ³ 30) Among U.S. Adults,
2013 40

Figure 3.3: Prevalence of Obesity Among Adults in the U.S., 2012 40

Figure 3.4: Percentage of Obese Children and Adolescents in the U.S., 1999-2012
41

Figure 4.1: Sales Forecast for the Global Diabetes Drug Market, 2012-2019 60

Figure 4.2: Sales Forecast for the U.S. Diabetes Drug Market, 2012-2019 60

Figure 4.3: Percentage of U.S. Diabetics Taking Medications, 2010-2012 62

Figure 4.4: U.S. Non-Insulin Anti-Diabetic Drug Market by Volume, 2014 64

Figure 5.1: Global Non-Insulin Anti-Diabetes Prescriptions by Drug Class, 2014
71

Figure 5.2: Global Non-Insulin Anti-Diabetes Sales by Drug Class, 2014 71

Figure 5.3: GLP-1 Market Share by Brand, 2014 73

Figure 5.4: GLP-1 Market Share of Key Players, 2014 74

Figure 5.5: DPP-4 Inhibitor Market Share by Brand, 2014 75

Figure 5.6: DPP-4 Inhibitor Market Share of Key Players, 2014 76

Figure 5.7: Overview of GLP-1 and Blood Glucose 82

Figure 5.8: Overview of DPP-4 Inhibitors and Blood Glucose 86

Figure 5.9: SGLT-2 Inhibitor Mechanism of Action 89

Figure 6.1: Worldwide Insulin Market Share (Value), 2014 108

Figure 6.2: U.S. Insulin Market Share (Value), 2014 108

Figure 6.3: Short-Acting Human Insulin Worldwide Market Share by Company, 2014
116

Figure 6.4: Rapid-Acting Insulin Worldwide Market Share by Company, 2014 118

Figure 6.5: Intermediate-Acting Human Insulin Worldwide Market Share by Company,
2014 121

Figure 6.6: Long-Acting Insulin Worldwide Market Share by Company, 2014 122

Figure 6.7: Market Share of Basal Insulins in Emerging Markets, 2014 123

Figure 6.8: Global Sales of Lantus, 2005-2014 124

Figure 6.9: Global Sales of Levemir, 2011-2014 125

Figure 6.10: Insulin Pump Market Share, 2014 160





INDEX OF TABLES



Table 2.1: Regional Estimates of the Number of Diabetes (20-79 Years) in
Millions, 2015 and 2035 18

Table 2.2: Top Ten Countries with the Largest Estimated Number of Diabetics (20
to 79 Years Age Group),

2015 and 2035 19

Table 2.3: Worldwide Undiagnosed Diabetes in Adults (20-79 Years) by Region and
Income Group, 2013 19

Table 2.4: Countries with the Largest Number of Deaths Attributable to Diabetes,
2013 20

Table 2.5: U.S. Population of Diagnosed Diabetics Aged 20-79 Years, 2013 22

Table 2.6: Percentage of U.S. Adults with Diagnosed Diabetes by State, 2010 23

Table 2.7: Cost of Diagnosed Diabetes in the U.S. 27

Table 2.8: Annual Cost of Care of United Healthcare Adult Members with Diabetes
29

Table 2.9: Healthcare Utilization by Diabetic Patients 29

Table 3.1: International Diabetes Federation (IDF) Diagnostic Criteria for
Metabolic Syndrome 34

Table 3.2: Ethnic Specific Values for Waist Circumference in IDF's Metabolic
Syndrome Criteria 34

Table 3.3: American Heart Association and National Heart, Lung, and Blood
Institute (AHA/NHLBI) Diagnostic Criteria for Metabolic Syndrome 34

Table 3.4: Additional Metabolic Criteria for Research 36

Table 3.5: Ten Leading Diagnoses for Co-Morbid Chronic Diseases in the U.S. 42

Table 3.6: Prevalence of Complications Among Patients with Diabetes 43

Table 3.7: Odds Ratio of Progression to Complications Associated with Type 2
Diabetes 44

Table 3.8: Novel Risk Factors and Possible Mechanisms of the Excess Risk of
Coronary Heart Disease in Type 2 Diabetes Mellitus 44

Table 3.9: Major Causes of End-Stage Renal Disease 44

Table 3.10: Clinical Recommendations for Adults with Diabetes 45

Table 3.11: Laboratory Assessment of Diabetic Vascular Disease 45

Table 3.12: Average Years Gained Free of Diabetes-Related Disease with Intensive
Management 46

Table 4.1: Global Randamp;D Spending in the Pharmaceutical Industry, 2010-2014 47

Table 4.2: Pharmaceutical Companies Ranked by Total Randamp;D Expenditures, 2014 47

Table 4.3: Leading Therapy Classes for Randamp;D, 2014 48

Table 4.4: Leading Disease Indications for Randamp;D, 2014 49

Table 4.5: Cost of Clinical Trial Protocol Procedure by Endpoint Type, 2012 49

Table 4.6: Global Pharmaceutical Sales by Region and Country, 2013 and 2018
(estimated) and CAGR 2009-2013 and 2014-2018 (estimated) 50

Table 4.7: World Pharmaceutical Sales Share by Region, 2013 51

Table 4.8: Leading Ten Therapeutic Classes by Global Sales, 2010-2014 52

Table 4.9: Estimated Leading Therapy Classes by Global Sales in the Developed
Market, 2018 52

Table 4.10: Estimated Leading Therapy Classes by Global Sales in the Pharmerging
Market, 2018 53

Table 4.11: Leading Therapeutic Classes by U.S. Sales, 2010-2014 53

Table 4.12: Top Selling Drugs Worldwide by Sales, 2014 53

Table 4.13: Top Selling Drugs in the U.S. by Sales, 2014 54

Table 4.14: Top Ten Global Pharmaceutical Companies by Global Sales, 2014 54

Table 4.15: Worldwide Anti-Diabetes (Insulin and Non-Insulin) Drug Market,
2012-2019 55

Table 4.16: U.S. Anti-Diabetes (Insulin and Non-Insulin) Drug Market, 2012-2019
55

Table 4.17: Anti-Diabetic Therapy Markets, 2014 56

Table 4.18: Top Ten Branded Anti-Diabetics by Sales Worldwide, 2014 59

Table 4.19: Top Ten Branded Anti-Diabetics by Monthly Prescriptions Worldwide,
2014 59

Table 4.20: American College of Physicians 2012 Practical Guideline for the Use
of Anti-Diabetes Drugs for Type 2 Diabetes 61

Table 4.21: Summary of Glucose-Lowering Interventions as Monotherapy 62

Table 5.1: Classes of Non-Insulin Hypoglycemic Agents 68

Table 5.2: Branded Non-Insulin Hypoglycemic Drugs Used to Treat Type 2 Diabetes
in the U.S., 2014 69

Table 5.3: Relative Efficacy of Diabetes Drugs 70

Table 5.4: Worldwide Non-Insulin Anti-Diabetes Drug Market, 2012-2019 72

Table 5.5: U.S. Non-Insulin Anti-Diabetes Drug Market, 2012-2019 72

Table 5.6: Diabetes Drugs Approved for U.S. Market, 2014 and 2015 73

Table 5.7: GLP-1 Drug Revenues in 2014 74

Table 5.8: DPP-4 Inhibitor Revenues in 2014 75

Table 5.9: SGLT-2 Inhibitor Revenues in 2014 76

Table 5.10: Fixed-Dose Oral Anti-Diabetes Drug Combinations 92

Table 5.11: GLP-1 Agonist Pipeline: Selected Drugs in Development 95

Table 5.12: DPP-IV Inhibitor Pipeline: Selected Drugs in Development 98

Table 5.13: SGLT-2 Inhibitor Pipeline: Selected Drugs in Development 99

Table 5.14: Fixed-Dose Combination Drugs with SGLT-2 Inhibitor: Selected Drugs
in Development 99

Table 5.15: Summary of Emerging Non-Insulin Anti-Diabetes Drug Categories 101

Table 6.1: Value Market Shares of Animal, Human and Modern Insulin, 1995-2014
105

Table 6.2: Worldwide Insulin Market, 2012-2019 106

Table 6.3: Worldwide Insulin Sales and Market Share by World Region, 2014 106

Table 6.4: U.S. Insulin Market, 2012-2019 106

Table 6.5: Key Drivers of the Type 2 Diabetes Insulin Market, 2014 107

Table 6.6: Worldwide Insulin Market by Type (% Market Value), 2014 107

Table 6.7: Worldwide Insulin Sales and Value Market Share by Company, 2014 107

Table 6.8: U.S. Insulin Sales and Value Market Share by Company, 2014 108

Table 6.9: Insulins on the U.S. Market 112

Table 6.10: Pharmacokinetics of Therapeutic Insulins on the U.S. Market 113

Table 6.11: Comparison of Recommendations from Existing Guidelines 115

Table 6.12: Pharmacokinetics of Short-Acting Human Insulins 115

Table 6.13: Short-Acting Human Insulin Worldwide Market Revenues, 2011-2014 116

Table 6.14: Pharmacokinetics of Rapid-Acting Insulins 117

Table 6.15: Rapid-Acting Insulin Worldwide Market Revenues, 2011-2014 118

Table 6.16: Pharmacokinetics of Intermediate-Acting Insulins 120

Table 6.17: Intermediate-Acting Human Insulin Worldwide Market Revenues,
2011-2014 120

Table 6.18: Pharmacokinetics of Long-Acting Insulins 121

Table 6.19: Long-Acting Insulin Worldwide Market Revenues, 2011-2014 122

Table 6.20: Pharmacokinetics of Insulin Mixtures 127

Table 6.21: A Comparison of Existing Insulin Delivery Devices 141

Table 6.22: Insulin Pens 143

Table 6.23: Estimated Worldwide Demand for Insulin Pens by Volume, 2013-2018 145

Table 6.24: Injection Aids 146

Table 6.25: Jet Injectors 148

Table 6.26: Control Averages by Treatment 149

Table 6.27: Reduced Risk for Various Diseases When Blood Glucose is Near Normal
149

Table 6.28: Leading Insulin Pump Manufacturers 150

Table 6.29: Comparison of Current External Insulin Pumps on the Market 150

Table 6.30: Insulin Infusion Sets 156

Table 6.31: Worldwide Insulin Pump Market, 2013-2019 160

Table 7.1: Advantages and Disadvantages of Newer Type 2 Diabetes Therapies 163

Table 7.2: Cells of the Pancreas 169

Table 8.1: BRIC Countries, Percentage of GDP Spent on Healthcare, 2013 180






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