Unlocking the Therapeutic Value of Incremental Innovation: A Smarter Approach to Treat Diabetes

Dr Ashok Jhingan, Director, Delhi Diabetes and Metabolic Research Centre elucidates on the importance of winning the battle against NCDs

2030 may be distant in the future but for WHO’s sustainable development goals (SDG 3.4), only a decade is left to reducing one-third of the premature mortalities from non-communicable diseases (NCDs). One of the most prevalent types of NCDs, diabetes affects 425 million people worldwide. In India alone, there will be a surge from the present 69.2 million people to 98 million people with diabetes by 2030. From lifestyle modifications to the monitoring of sugar and insulin in the vitals, we have come a long way towards treating diabetics. But with diabetes affecting people sooner due to obesity and a weak immune system, there is a greater risk of developing cardiovascular diseases such as heart attacks, heart failure, hypertension, etc. With the clock ticking and rapidly changing patient demography, we need to advance in the field of pharmaceutical innovations.

For many decades, India has been relying on the merit of affordable generics. But did you know that a ‘generics-only’ model cannot substitute the therapeutic power of branded generics? Let’s understand why India needs to move beyond mere cheaper alternatives and allow its patients access to smarter innovations i.e. branded generics.

Incremental innovation to the rescue

Whether it’s type-1 auto-immune diabetes or type-2 adult onset diabetes, the solution lies in constant innovation in the existing therapy i.e. incremental innovation. With the underlying objective of improving patient outcomes, pharmaceutical companies have been investing in developing newer and effective alternatives to existing drug molecules (branded generics). New medicines coming as a result of incremental innovation can prove to be more effective in improving patient compliance through better dosage and forms of administration. With strenuous research in practice, the improved medicine can have fewer side effects and reduced toxicity.

A case in point— diabetes

Developed in the mid-1990s, new oral agents and insulin analogues have helped in managing the symptoms as well as improving glycaemic control. These new agents also allow individualised treatment. For instance, for patients who face difficulty in preparing their injections, there exists premixed preparations of insulins ensuring improve compliance, greater dosage accuracy, and reduced risk of hypoglycaemia.

With time there has been an increased demand of these category of drugs, owing to the increased burden of diabetes. This necessitates the need to have multiple options within the same therapeutic class i.e. product alternatives or branded generics to ensure treatment that is better tailored to individual patient needs, since not every patient responds to every drug in the same manner.

Such developments have set the global innovation curve on a rise; however, India is still grappling with its own set of complications. For a country that shares the maximum burden of diabetes in the world, is it possible to defeat the crippling disease burden with the existing line of treatment?

Let’s take a look at what’s keeping India away from the innovation curve that the world is riding on.

India’s tryst with “Innovating”: An ongoing battle

While we celebrate the technological advancements in the management of diabetes, the existing legal framework i.e. Intellectual Property Rights does not favour the growth of newer molecules. Take, for instance, the case of the World Trade Organisation Trade-Related Aspects of Intellectual Property (IP) Rights (TRIPS) agreement to protect innovations. Although India is a signatory to the agreement, it does not grant patents to new forms of known substances unless they differ significantly in their properties or efficacy. This gap pushes incremental innovations to the back-seat and limits a patient’s access to smarter treatments.

Therefore, to refrain from being the “diabetes capital of the world”, the government and the industry can work in tandem for the patient’s good. The partnership can help build a strong ecosystem where the policy framework incentivises the innovations done by the pharma sector. By developing new or improved uses for existing therapeutics, research-based pharmaceutical companies can help find solutions for better patient outcomes.