The bad news is that diabetes is on the rise; the good news is that consumers have access to a growing arsenal of products designed to combat the disorder. Elizabeth Sloan, PhD, looks at what manufacturers are bringing to the table to counter the various diabetes conditions
With more than one million new cases per year, diabetes has reached epidemic proportions in the US. As a consequence, the market for diabetic products is exploding, helped by media reports littered with buzz words and phrases such as Syndrome X, diabesity and insulin health. Indeed, widespread insulin resistance, including the advent of adult-onset diabetes in children, has become so serious that the Department of Health and Human Services has launched an educational campaign to address the problem.
The Size Of The Problem
Since 1991, the incidence of type 2 diabetes, also known as adult onset or non-insulin dependent diabetes, has risen by 33 per cent. Those who suffer from this type of diabetes can control their blood glucose levels through diet, exercise, weight control and oral medications. According to the National Institutes of Health (NIH), 8.6 per cent (17 million) of Americans aged over 20 have diabetes while 5.9 million remain undiagnosed. Of those who have been diagnosed, 9.1 million are women, compared with only 7.8 million male sufferers. African Americans and Latin Americans are more likely to have diabetes than other groups, representing 13 and 10.2 per cent of diabetics, respectively.
New Jersey-based Multi-sponsor Surveys predicts the incidence of diabetes will jump by 19.4 per cent by 2010, ranking after menopause, prostate cancer and heart disease as America's fastest growing health condition (See Figure 1). One in every 400 to 500 children/teens has type 1, or insulin-dependent diabetes. Type 2 diabetes, until recently seen almost exclusively in adults, afflicts four per cent of children and is growing rapidly.
Insulin resistance and pre-diabetes represent two enormous new market opportunities, as they potentially affect 30 to 80 million Americans. Insulin resistance is a condition where muscle, fat and liver cells have lost insulin sensitivity to the point that glucose does not enter the cell. Excess glucose builds up in the blood stream, triggering more insulin production and leaving high levels of glucose and insulin circulating in the blood.
Factors such as genetics, excess weight and lack of exercise accelerate the condition, as does high blood pressure, high levels of low-density lipoproteins (LDLs) and triglycerides, and low levels of high-density lipoproteins (HDLs). Insulin resistance and pre-diabetes have no symptoms, but a person with any three of the following risk factors is medically classified as having metabolic syndrome, also known as Syndrome X: a family history of diabetes; central obesity/waist circumference of >40 inches for men and 35 inches for women; triglycerides >150mg/dL; HDLs <40mg/dL for men and 50mg/dL for women; blood pressure >130/85mm Hg; and fasting glucose >110mg/dL.
People with glucose levels that are higher than normal, but not yet in the diabetic range, have pre-diabetes, also called impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), depending on the test used to diagnose it. The NIH reports that 16 million or 15.6 per cent of the population aged 40 to 74 have IGT and 10 million (9.7 per cent) have IFG. Most pre-diabetics develop type 2 diabetes within 10 years.
Diabetic Products: Consumers Fight Back
The Natural Marketing Institute (NMI) in Pennsylvania reports that nearly two-thirds of American households are trying to prevent developing diabetes. According to the 2003 Trends Report, from Atlanta-based HealthFocus, 37 per cent of American adults are "very/extremely concerned" about developing diabetes. Nearly two-thirds want to learn more about how foods can help manage their blood sugar and half want more information on the glycemic index and blood sugar/insulin.
Marketing to diabetics has been big business for some time. The average diagnosed diabetic spends approximately $3,000 per year at the chemist, managing and treating the disorder. Some 11 per cent of diagnosed diabetics take insulin and oral medications, 22 per cent take insulin only, 49 per cent oral medications only, and 17 per cent take neither one. Nutrition Business Journal reports that diabetes-specific dietary supplement sales reached $438 million in 2001, up 6.6 per cent on the year before. Frost and Sullivan predicts glucose self-monitoring kit sales will jump from $2.6 billion to $4.5 billion by 2009.
A wide range of supplement ingredients is used for blood-glucose control, such as chromium, chromium picolinate, alpha-lipoic acid; Gymnema sylvestre, fenugreek, magnesium, selenium, psyllium and zinc. Other ingredients which have been used for the same purpose, include fatty acids/omega-3s, banaba, nearly all forms of ginseng, bitter lemon, nopal, karela, tronadora, vanadium, aloe vera and maitake. In 2002, New York-based Nutrition 21 introduced Diachrome, made from chromium picolinate and biotin, which has been shown in clinical studies to significantly improve cholesterol profiles in people with type 2 diabetes.
Four major trends characterise the diabetic, pre-diabetic and insulin-resistant supplements markets. Firstly, products are being formulated to help manage and prevent the risk factors and consequences of diabetes. For example, Twinlab's Dia-Balance Diabetic Health Formula line—for diabetics and pre-diabetics—offers weight, eye, circulation, glucose control and multivitamin products. Secondly, a new wave of supplements, including Insulin Health X-Factors from Trace Minerals Research, is focused on ensuring insulin health. Thirdly, dozens of brands, including Glucosol, launched by Doctor's A-Z and Sugar Balance from Natural Care, help control blood glucose levels. Lastly, cutting-edge products, like PharmaPure's Sugar Blocker and Starch Away from Leiner Health Products, are delivering clever ways of blocking sugar absorption and helping people to lose weight.
The potential for combination supplements is also tremendous. Diabetics are four times more likely to develop heart disease, three-quarters suffer from high blood pressure, two-thirds have some form of nervous disorder, and one-third has serious periodontal disease. Sleep disorders are a common problem. Diabetes is also the leading cause of new cases of blindness, 42 per cent of kidney diseases and 60 per cent of lower limb amputations. There are also relatively unexplored opportunities in eye, gluten-free and diabetic natural personal care products.
Diet: An Effective Weapon
Consumers well understand that diet is a valuable tool for managing and preventing diabetes. Although the American Dietetic Association confirms that total carbohydrate intake is the real villain, consumer perception is that sugared products are to blame. Not surprisingly, sugar is closing in on fat as America's top nutritional concern. Multi-sponsor Surveys reports that just more than half the people it interviewed made a strong effort to reduce sugar in 2002, up eight per cent over 2001. A third of consumers prefer foods with no added sugar and 40 per cent check food packaging for forms of sugar, according to the NMI. Mothers are also more likely to limit children's products containing sugar than fat. In HealthFocus' shopper survey, sugar-free is still "very/extremely important" to one-third of shoppers.
Recently, major sweet goods manufacturers, including Kraft Nabisco and Kellogg's/Keebler, have introduced low- sugar and sugar-free lines of several of their leading cookie brands. The Carb Solutions brand, which grew by 266.9 per cent last year, led gains in the mass-market bar category. Other interesting new products included Carbolite's new At Last! low glycemic index candy bar, Russell Stover's low-carbohydrate candy line and the first ever low-carbohydrate drinking milk, under Southwest Foods' LeCarb brand.
Four out of 10 consumers are aware of the positive role of dietary fibre in the prevention and management of type 2 diabetes. Consequently, innovative forms of fibre, such as psyllium, resistant starch, fructo-oligosaccharides and glucomannan, are finding a new role in this emerging market. Old forms, like whole grains, are also doing well, says Multi-sponsor Surveys. A Harvard Medical School study has shown that peanut butter and nuts—particularly almonds—lower the risk of type 2 diabetes in women, while whole grains improve insulin sensitivity and lower cholesterol. The phytochemical pterostilbene, found in grapes (not wine), has been identified as having anti-diabetic effects. Dairy products have also been shown to lower blood sugar levels and body mass because they contain conjugated linoleic acid. In addition, preliminary evidence from the US Department of Agriculture and George Washington University suggests that that a combination of soy protein, which is associated with isoflavones, and flaxseed, which is rich in lignans, improves glucose control and insulin resistance.
Apart from these previous examples, low glycemic index foods are the latest examples of diabetic products to hit the market. In Sweden, Primaliv i Balans yoghurt carries a 'balances your blood sugar' claim, due to its oat beta-glucan content. Some products in New Zealand now carry a glycemic index rating and Australia has a low glycemic symbol for foods.
Whilst these claims are gaining credibility abroad, it is important to note that in the US the Institute of Medicine's Food and Nutrition Board did not give its support to a recommendation involving the glycemic index and recommended levels of macronutrients. It noted: "There is insufficient evidence of the glycemic index's relationship to chronic diseases."
Sloan Trends' TrendSense Model, which has been used for more than 10 years to separate nutraceutical fads from long-term trends, indicates that the glycemic index may yet be a passing phase. Although low glycemic index foods are currently finding a welcome market among health food and specialty store channels, as well as among the very health conscious and condition-specific shoppers, they have yet to cross the medical threshold, which would signal the beginning of a long-term market trend.
According to the International Diabetes Federation, type 2 diabetes currently affects one in 20 European adults (22.5 million people) and is predicted to increase by six million by 2025. Around the world, diabetes affects more than 150 million people and this figure is set to rise to 300 million by 2025. So, diabetes is certainly not just a US problem. It affects the whole world and therefore represents a huge opportunity for consumer goods manufacturers.
A Elizabeth Sloan, PhD, is president of California-based Sloan Trends & Solutions, Inc
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