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Diabetes, Metabolic Syndrome and Cardiovascular Disease

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Publication Date:
January 2016; Pages: 355
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Diabetes Metabolic Syndrome Sample

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

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 R&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 α-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 & 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 & Development 206
9.35 Johnson & 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 & 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 R&D Spending in the Pharmaceutical Industry, 2010-2014 47
Table 4.2: Pharmaceutical Companies Ranked by Total R&D Expenditures, 2014 47
Table 4.3: Leading Therapy Classes for R&D, 2014 48
Table 4.4: Leading Disease Indications for R&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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