There is an increasing incidence of diabetes in the rural population in India. Five years ago, the country reported only a handful of cases, but now 2.5 per cent of the rural population suffers from the disease. There is also an abnormal glucose tolerance (AGT) in rural areas along with rising complications arising out of diabetes.

According to C Munichoodappa, physician-diabetologist and managing director Bangalore Hospital, the incidence of rural population being affected with diabetes is an alarming trend. Other well known diabetologists also concurred with the view that the trend of increasing diabetes cases in rural India is alarming.

One factor contributing to a high rate of diabetes is an increase in migration of rural people to urban areas in search of jobs. This has resulted in change in food habits and lack of exercise. The country reports 44 million cases of diabetes. Earlier, the rural-urban disparity in diabetes was due to a low prevalence of overweight and obese population in rural areas compared to cities.

In the wake of the growing incidence, doctors from Victoria Hospital, Bowring & Lady Curzon Hospital and primary health centres in Bangalore Rural are insisting on increasing the number of screening camps for early identification of eye and foot related diabetic complications. When patients come in for treatment in the last stages, it is difficult to treat the complication. In the early stages of diabetes, oral drugs, diet and physical exercise could control sugar levels, said Dr Munichoodappa.

But there are increasing number of cases where tablets don't work and in such cases insulin administration becomes inevitable, he added.

Diabetes can be controlled with modern insulin and doctors are of the view that its early administration could prevent many of these life threatening complications resulting out of uncontrolled diabetes. But in the rural areas, it is difficult to prescribe insulin because of cost and the fear of prick.

"With insulin coming under the ambit of Drug Price Control Order, prices should come down further to make it affordable. With the expanding usage of insulin, prices need to fall further because volume growth can sustain and profit growth," stated VR Kannan, pharma consultant.

Further, with the emergence of fine needle, disposable syringes and the pen technology, insulin delivery has become more user-friendly.

Modern insulin analogues are major advancements in the management of diabetes. Diabetologists are able to prescribe treatment regimens that are tailored to meet the individual needs of each patient, stated Dr Munichoodappa.

Novo Nordisk, which is a pioneer in modern insulin, has the complete range of rapid acting, long acting and pre-mix versions. The company's Novo Mix 30 which is the flagship brand is ranked in the top 100 products amongst the 20,000 pharma brands in the country.

Insulin market is estimated at Rs 300 crore and growing at 18 percent per annum. In the modern insulin space, players include Novo Nordisk which holds over 62 percent of the market. Other players are Eli Lily and Aventis.