There isn’t a word for diabetes in
traditional Chinese medicine, but Chengzhi Xia knows it when he
sees it. And he says he’s seeing much more of it these days.
Xia and other healers in affluent central Shanghai describe
the disease by one of its symptoms, a raging thirst. Patients
often seek relief from the side effects of modern drugs —
products sometimes outdated in the West.
“Western companies should have more innovative products to
give Chinese patients more choices,” Xia said in an interview
in his cubicle at Lei Yun Shang Pharmacy, where apothecaries
sift sharp-smelling medicinal herbs alongside modern pills.
He may soon get his wish. As diabetes rates soar in China,
drugmakers including Merck Co., Sanofi and Eli Lilly Co. (LLY) are
trying to unseat Bayer AG (BAYN) and Novo Nordisk A/S as the biggest
providers of diabetes medicines. At stake is a market that may
triple to $2.1 billion in annual sales by 2019 from $700 million
in 2009, says Yifi Liu, an analyst for Datamonitor in Shanghai.
“You should continue to expect double-digit growth in
China’s diabetes market for many years to come,” Kare Schultz,
chief operating officer of Novo Nordisk, said in a telephone
interview. The Copenhagen-based drugmaker is the country’s top
seller of insulin, which diabetes patients lack to convert blood
sugar into energy.
Beyond insulin, the pill to beat is a 17-year-old Bayer
drug called Glucobay, little used in the West but dominant in
China. Glucobay sales there surged 22 percent to 1.8 billion
renminbi ($283.4 million) last year, according to Bayer. The
medicine, now a generic, only garnered a fraction of that, or
$9.7 million in revenue, in the U.S. in the first nine months of
this year, according to data research firm IMS Health.
“We’re still winning market share” with Glucobay in
China, Bayer Chief Executive Officer Marijn Dekkers said at a
Nov. 15 dinner with journalists in Shanghai.
The medicine, a so-called starch blocker intended to cut
blood sugar after meals, is unpopular in the U.S. because it’s
not potent enough to justify its side effects, according to Tom Donner, head of the diabetes center at Johns Hopkins University.
Up to half of Glucobay patients experience loose bowel movements
and many complain of gas, he said in a telephone interview.
Yet it’s a logical option for a population with a diet high
in carbohydrates like that of China, said Datamonitor’s Liu.
Combined with Bayer’s marketing savvy, that may help explain why
the drug is so famous locally it has reached the status of
“pharmaceutical myth,” according to Liu.
Bayer, of Leverkusen, Germany, worked with physicians and
health authorities to help draft guidelines for diabetes
treatment. The company held round-table talks on diabetes with
influential doctors. It also set up Bayer Diabetes Community
Center houses, where people can get free drugs and prevention
literature and participate in patient activities, all under the
auspices of the Bayer brand name, Liu said.
Bayer also kept prices low, making Glucobay an affordable
option for a disease with few insurance-reimbursed therapies.
“The loyalty to the brand is very strong,” said Liu.
Even Xia, the traditional Shanghai doctor, proudly displays
his Bayer glucose meter, an instrument to measure blood-sugar
levels that he calls a preventive tool “for the future.”
The same pace of social change and urban prosperity that
has fuelled China’s economy in the past decade has fanned the
spread of Type 2 diabetes, the most common form of the disease,
as people ate fattier foods and led more sedentary lifestyles.
Type 2 diabetes linked to obesity affected almost 1 in 10
Chinese adults in 2008, the New England Journal of Medicine said
in a study published last year. That would be a higher rate than
in the U.S., where the National Institutes of Health estimates
8.3 percent of the population had diabetes in 2010. Another 148
million Chinese are on their way toward developing the disease.
The new generation of drugs that may relieve sufferers and
supplant Glucobay has already begun its march into China.
Merck’s Januvia went on sale last year, and Novo’s Victoza
became available in October. Lilly and Amylin Pharmaceuticals
Inc. (AMLN)’s Byetta won approval in 2009. All three work in different
ways to prompt the pancreas to make insulin, the hormone that
diabetics need to break down the sugar that builds up in their
Bayer’s dominance, while under threat, probably won’t
evaporate overnight. Next-generation drugs take about five to
six years to penetrate the market, delayed by requirements for
clinical testing inside China, according to Novo’s Schultz. Once
the medicine goes on sale, demand tends to pick up only after
it’s added to insurance reimbursement lists.
“The sales are insignificant until we get on the
reimbursement,” Schultz said. Until then, only the fewer than
10 percent of the population willing to pay out-of-pocket will
be able to buy Victoza, he said.
Sanofi introduced its Lantus insulin in 2004. The French
drugmaker said local sales had doubled in the third quarter of
2011 after the medicine was included in reimbursement lists in
Shanghai last December and Beijing in July.
The first new therapies are likely to be added to insurance
payers’ lists by 2013, according to Datamonitor’s Liu.
By 2016, newer classes of drugs will be the fastest-growing
diabetes medicines in China, estimates Vineet Kashyap, an
analyst for IMARC Group in New Delhi. Medicines such as Januvia,
Victoza and Byetta are likely to hold 17 percent of the market
by then, approaching the one-quarter share estimated for drugs
in Glucobay’s class of starch blockers, Kashyap said.
Eventually, new drugs may come from within China. At the
diabetes institute of Shanghai Jiao Tong University Affiliated
6th People’s Hospital, dozens of journal publications hang on
the wall next to the office of director Weiping Jia, who led the
Shanghai portion of the diabetes study published in the New
England Journal of Medicine.
Ten years ago, Jia’s diabetes center saw about 70 patients
a day. Now seven times as many travel from across the country
for treatment or screening, she says. The center’s research has
helped define two genetic variations that may play a stronger
role in diabetes in Chinese populations than in Caucasians,
according to Congrong Wang, one of the institute’s doctors.
“In the future, it’s possible that if we find a certain
genetic background we can use a more individual therapy,” Wang
Mingzhao Xing, a professor of medicine, endocrinology and
metabolism at Johns Hopkins, blames “a dramatic change in
people’s lives” affecting diets, culture and medical care for
the recent flare-up of one of the oldest disease known to man.
“In Chinese medicine 2,000 years ago, people knew urine
could be sweet and people would be thirsty — they knew the
signs of diabetes,” Xing said. “But it wasn’t common.”
To contact the reporter on this story:
Naomi Kresge in Shanghai at
To contact the editor responsible for this story:
Phil Serafino at