The Hindu : The challenge of diabetes

Online edition of India's National Newspaper
Tuesday, Aug 19, 2003

Opinion

Opinion - Editorials

The challenge of diabetes

DIABETES IS A major public health concern as more and more people are falling prey to the disease in both the developed and the developing world. The World Health Organisation estimates the number of diabetics in India today at 30 million compared with 19.7 million in 1995. Animal insulin harvested either from pigs or cows has been a traditional source but it does not have the same amino acids as human insulin. While porcine insulin differs from the human type in one amino acid, the difference is two between bovine and human insulin. This difference is overcome by changing the amino acid to make it `similar' to human insulin. One company continues to sell in India such semi-synthetic `humanised' insulin in the name of human insulin while marketing yeast-based recombinant insulin internationally. The success of Wockhardt, an Indian pharmaceutical company, in producing human insulin, Wosulin, through the recombinant technology to combat diabetes has come at the right time. Human insulin is so called not because it is extracted from the human body but because it is structurally and chromatographically similar to the one produced by humans. Apart from bypassing the animal insulin route, Wockhardt has gone in for a yeast species Hansenula polymorpha rather than the bacterium E.Coli as the host. Unlike E.Coli, which poses certain inherent problems, yeast secretes insulin outside the cell as a processed and properly folded proinsulin molecule. Higher productivity is achieved when yeast is used. Wockhardt's breakthrough gains importance as it is the fourth company in the world — and the first outside the U.S. and Europe — to master the technology. This mastery comes in eight years after the first recombinant human insulin was commercialised in India.

The global insulin market is presently valued at over $3 billion. The Indian market alone is valued at Rs. 250 crores. The huge demand notwithstanding, pharmaceutical companies around the world have been unable to crack the technology. The breakthrough by an Indian company is to be comprehended against this backdrop. A splendid advantage for the new Indian product is that Wosulin costs the same as porcine insulin. It is priced even lower than `humanised' insulin, and is nearly 50 per cent cheaper than a similar yeast-based recombinant human insulin. This competitive advantage, which can be of great benefit to society, stands out even in a market where some companies have effected a sudden 35-40 per cent reduction in price.

The availability of cheaper and technologically superior insulin should not, however, be a cause for complacency. The WHO estimates that the disease burden in India will increase to 80 million by 2030; this is 23 million more than the original estimate for 2025. Where the WHO erred was in the underestimation of the adverse impact of relative affluence and lifestyle changes on the incidence of diabetes in society. Given the pace of these lifestyle changes, even 80 million cases by 2030 may turn out to be an underestimate. Medical data suggest that, in an international comparison, Indians have a relatively high genetic predisposition towards diabetes. This in combination with sedentary lifestyles, the consumption of fat-rich food, and increased longevity increases the risk. Medical data also suggest that urban Indians are more prone to affliction by diabetes than rural Indians, and people of Indian origin in the United States and Europe more than the Indian population. Until such time as a cure is found, prevention is the only way out. Even after a cure is found, prevention will remain the best way by far. For this a massive public awareness campaign in both urban and rural India becomes an imperative.

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