Even as the average compounded prescription growth in the pharma market for the last two years stood steady at 3 per cent, the Rs.800 crores anti diabetes market witnessed a growth of 9 per cent, says a prescription audit report from ACNeilsen ORG-MARG.

Trends within the anti-diabetes market indicate a growing preference for combination therapy. A gradual shift towards combination therapy as doctors reduce their preference for prescribing plain Oral Hypoglycemic Agents or OHAs. The share of combinations, especially those that combine pioglitatzone and glimepride with metformin appear to be on the rise.

"The base of diabetes patients in India is poised to grow almost 57 million over the next few decades. At this current trajectory, India will be the largest market for anti-diabetic treatments by a large margin amongst emerging markets and developing economies," comments Gauri Pathak, senior manager, ACNielsen ORG-MARG Pharma.

The survey audit also found that despite a movement towards combinations, diabetologists prefer to co-prescribe OHAs. "This indicates that diabetologists still choose to experiment and titer dosages of the available molecules rather than opt for newer combination products," elaborates Pathak.

Despite the widespread availability of combinations, diabetologists tend to recommend a sulphonylurea (glibenclamide / glimepride) in conjunction with a biguanide (metformin) and a glitazone (pioglitazone/rosiglitazone). The surge in the average number of brands prescribed per prescription by diabetologists from 368 per 100 prescriptions to 414 per 100 prescriptions is a reflection of this, the report noted.

Glibenclamide prescriptions written as a monotherapy have reduced significantly over the last three years (33 per cent v/s 52 per cent) while the proportion of combinations as monotherapy remains much higher comparatively.

The new molecule pioglitazone has witnessed an eight-fold growth in co-prescriptions (from 10,800 to 82,000) despite being available in a combined form with metformin. The new glitazones are mainly co-prescribed alongwith metformin and a sulphonylurea or a combination of the two.

Monotherapy with OHAs for Diabetologists

	2001	2003
Plain OHA
Glibenclamide	0.52	0.33
Gliclazide	0.36	0.21
Glipizide	0.55	0.31
Glimepride	0.56	0.38
Metformin	0.25	0.18
Rosiglitazone	0.16	0.08
Pioglitazone	0.11	0.09
OHA Combinations
Glibenclamide+Metformin	0.75	0.52
Gliclazide+Metformin	0.61	0.53
Glipizide+Metformin	0.83	0.69

Source: Scrip Count Anti-diabetes Report

Opines Pathak, "it is becoming increasingly clear that pharma companies within fast growing chronic categories can no longer simply rely on broader trends in terms of sales offtake. The prescription habits of the speciality doctor, the most important channel for determining sales, will also have to be studied closely if companies hope to make the most of emerging trends".