Diabetes is running at record levels worldwide and half the people estimated to have the disease are, as yet, undiagnosed, according to a report on Wednesday.
The number of people living with diabetes is now put at 371 million, up from 366 million a year ago, with numbers expected to reach 552 million by 2030, the International Diabetes Federation (IDF) said.
Diabetes is often viewed as a western problem, since the vast majority of people have type 2 disease which is linked to obesity and lack of exercise.
But the disease is also spreading rapidly in poorer countries, alongside urbanization, and four out of five diabetics now live in low and middle-income countries, opening up new opportunities and challenges for the drug industry.
China alone has 92.3 million people with diabetes, more than any other nation in the world, and the hidden burden is also enormous in sub-Saharan Africa where limited healthcare means less than a fifth of cases get diagnosed.
The IDF estimates that, globally, 187 million people do not yet know they are suffering from the condition.
Diabetics have inadequate blood sugar control which can lead to serious complications, including nerve and kidney damage and blindness. Worldwide deaths from the disease are running at 4.8 million a year.
The disease is one of a number of chronic conditions – along with cancer, cardiovascular and respiratory diseases – that healthcare campaigners want included in the next set of global development goals, which will replace outgoing Millennium Developments Goals in 2015.
For the international drugmakers, diabetes offers riches, with global sales of diabetes medicines expected to reach $48-$53 billion by 2016, up from $39.2 billion in 2011, according to research firm IMS Health.
China to Africa
Tapping into the potential of increased demand in emerging markets, however, requires a twin-track approach from drug companies which have traditionally focused on pricey new therapies for rich-world markets.
These days, there is a lot more focus on high-volume but lower-margin business in developing economies, many of which are predicted to show high double-digit percentage sales growth for diabetes medicines for years to come.
The shift is already yielding results.
China, for example, is now the second-largest market behind the United States for the world's biggest maker of insulin – Danish group Novo Nordisk. It is also a major focus for rivals such as Eli Lilly, Merck & Co, and Sanofi.
Poorer countries are more difficult, especially when it comes to insulin, which must be kept cool if it is not to deteriorate. While most patients start on cheap generic diabetes pills, such as metformin, many need insulin as their disease progresses.
Still, Novo Nordisk thinks it has cracked part of the problem in Kenya, where a project using churches and other local groups has reduced the number of middlemen in the supply chain and cut the cost of a month's supply of insulin to around 500 Kenyan shillings ($6).
So far, the project only covers around 1,000 Kenyans, but Jesper Hoiland, Novo's head of international operations, is confident his company's low-price model will become profitable as it increases in scale. "It will take three to five years to get to break even," he said in an interview.
In the meantime, similar pilot schemes are being tested in rural India and Nigeria.
Other major drugmakers like Sanofi, which has a significant presence in Africa, are also adopting "tiered" or differential pricing to open up developing world markets.