The winners of the NovoCare™ painting competition for Indian children with diabetes have the honour of seeing their paintings printed as postcards that are sold to raise money for poor Indian children with diabetes..

The growth rate of Novo Nordisk's Health Care products in India is expected to increase up to twice as fast as that of the general world market. General manager Anil Kapur anticipates that especially pen systems will account for a larger and more significant share of the value of turnover. NovoLet® about to be introduced.

Novo Nordisk has only some 35 medical representatives in India, a country with 30 million people with diabetes. Nonetheless, the company has succeeded in increasing turnover of its health care products five-fold since 1990, which has given it a solid position on the Indian insulin market. Today, the diabetes market (insulin and oral hypoglycaemic agents) is worth around DKK 250 million, with oral drugs accounting for around 60% and insulin for 40%.
According to Anil Kapur, general manager of the Indian affiliate, the most significant reason for Novo Nordisk's success is the vast range of educational initiatives within diabetes treatment offered by Novo Nordisk in India. This strategy has meant that competitors such as Eli Lilly and Hoechst have been unable to market themselves through similar educational schemes and have to contend with fighting for much smaller market shares, despite intensive marketing activity and considerably larger sales forces than Novo Nordisk.
"As a result of our education strategy, the situation today is that to people who treat diabetes in India, the first company that comes to their minds is Novo Nordisk," says Kapur.
One of the most popular events is the annual conference, Novo Nordisk Diabetes Update, that attracts full houses of Indian physicians and diabetologists. This year's Diabetes Update, the sixth in a row, ran for two days and was attended by more than 350 influential doctors.
Despite its heavy investment in training and education, Novo Nordisk has a relatively low cost-to-sales ratio, thanks primarily to the fact that most of the activities are executed by the company itself, backed up by considerable voluntary work.
Another reason for the excellent sales figures is the alliance with Knoll-Magnus, a subsidiary of Knoll AG of Germany, whose 160 medical representatives represent a significant boost to Novo Nordisk's sales force. Together, the two companies dominate the Indian insulin market. Novo Nordisk's medical reps, or marketing executives, as they are called, may be few in number but they are in a class of their own - they all have a university degree, and 70% of them have an additional degree in marketing or business administration. This is a unique claim in the pharmaceutical sector in India.

Few receive treatment
"The decisive challenge to be met in the Indian diabetes market is to make sure patients start receiving treatment at an early stage. Diabetes is often diagnosed very late and we frequently see serious complications developing before patients start receiving treatment," says Kapur. "It is estimated that only some 10% of the estimated 30 million diagnosed people with diabetes in India are actually being treated. To increase this number, we must work towards a systematic improvement of Indian doctors' knowledge of the disease."
Changes in diet and lifestyle have led to the fact that no less than 12% of Indians living in urban areas today suffer from diabetes, compared to only 2% in rural areas. This huge disparity between town and country also reflects the fact that doctors with knowledge of the disease are found mainly in the towns.
Today, more than 98% of Indians with diabetes suffer from Type 2 diabetes. Of those with Type 2 diabetes undergoing treatment, 17% can manage with dietary measures and exercise. More than half use oral antidiabetics alone, 15% use a combination of insulin and oral drugs and another 15% insulin alone. "In a market dominated by oral products, it is crucial that our name is well-positioned for those cases diagnosed as insulin-dependent diabetes. The training programme we have taken part in over the last seven years, has created a greater insight into diabetes and promoted the use of insulin among Indian doctors, and the number who recommend insulin has risen," says Kapur.
It is hardly surprising that oral products have won such a large part of the Indian diabetes market - their prices, even those of international brands, are set considerably lower than insulin. Insulin therapy is typically ten times more expensive than treatment with oral antidiabetics and can easily represent up to 10% of the average income. Kapur thinks that the introduction of NovoNorm® may have a smaller than assumed impact on Novo Nordisk's market share in India in the future. NovoNorm® belongs to a completely new generation of oral products that presumably will be priced higher, because of its qualities, than other products on the intensely competitive Indian market for oral antidiabetics.
The price of a product is crucial to people with diabetes in India. Patients have to pay for their treatment themselves, as there is virtually no state subsidy nor insurance reimbursements for people with diabetes. There is not much hope that the future will bring better possibilities of state subsidy to the patients. India has severe and pressing health care needs, and resources are limited. Only considerable economic growth would change the conditions of the Indian diabetics.