How drug companies can help fix Vietnam's diabetes problem

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Diabetes is becoming an important health concern in Vietnam, reaching five million cases nationwide in 2013 after increasing 211 percent over the past 10 years.

At a time when Vietnam's malnutrition rate remains one of the highest in the region, where 40 percent of children under 5 are underweight and 36 percent are stunted, diabetes prevalence rates are highlighting critical public health problems at the other end of the spectrum.

The polarized health concerns of malnutrition and diabetes, where one is a result of the inability to afford enough nutritious food, while the other often attributed to lifestyle preferences, forces a funereal inspection of the country's economic development.

Vietnam's high GDP growth figures enriched primarily the wealthier urbanites of Hanoi and Ho Chi Minh City and continues to tip the scale of an already imbalanced urban-rural economic divide in Vietnam.

Disease of affluence?

It's not surprising then that "the rich man's disease," type 2 diabetes, caused primarily by lifestyle choices, accounts for 90 percent of diabetes in Vietnam (the other 10 percent is type I diabetes, primarily genetic).

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The type 2 variety drove the near-epidemic rise of diabetes, which affected one percent of the Vietnamese adult population in 1991 to six percent in 2012; the prevalence rate then jumped to 10 percent in urban centers according a study conducted in HCMC in 2010.

But type 2 diabetes in Vietnam is also showing a peculiar and unexplained trend diabetic patients are increasingly not obese, swaying the belief that a sedentary lifestyle with Western diets is the only primary cause of the diabetes.

The trend in Vietnam is following the course of countries like India, where recent screening studies of urban populations show alarming rates of diabetes in the poor, young and old.

The infrastructure burden

Affecting the wealthy and poor, young and old, the disease is becoming pandemic as 7-8 million are forecasted to be afflicted with the disease by 2025, causing stress on Vietnam's urban healthcare system where patients often flock to for treatment, bypassing commune and local hospitals perceived to be staffed with less-experienced healthcare professionals and outdated equipment.

The financial burden of the disease is also significant, currently costing 1.8 million identified diabetic patients about $380 million in treatment costs per year according to Solidiance, a management consulting firm focused on Asia Pacific.

"Spending on health is a key priority for individuals right now despite the relative slowdown in consumer spending. When people have disposable income much of it goes to healthcare as well as education," states Michael Sieburg, the manager of Solidiance's Vietnam office.

The other 3.2 million diabetic patients are unidentified, accounting for 64 percent of the country's diabetic population, living with diabetes without knowing it because of the lack of knowledge and lack of access to healthcare systems.

The low levels of detection is causing big concerns, as left untreated diabetes can cause life threatening complications such as blindness, nerve damage, cardiovascular diseases.

Untreated diabetic foot can develop ulcerations, infections and the eventual need to amputate and Vietnam is seeing an alarming rate of foot amputations as a result of diabetes, though no official statistics are available.

The problem remains severe nonetheless, as amputee patients tend to stay in hospitals for weeks, burdening overcrowded central hospitals, which already operate at over 200 percent capacity in some wards.

Government strategy

Such an alarmingly low detection rate is prompting Vietnam's leadership to prioritize diabetes screening and establish specialty wards in provincial hospitals.

At a conference held in 2013, Vietnam outlined the National Strategy on Diabetes Prevention, which will introduce training and technology to 60 percent of commune-level hospitals while 80 percent of provincial hospitals will receive funding to establish specialized screening wards.

These initiatives, according to the plan, should enhance the screening of diabetics and pre-diabetics, an important goal given that 13 percent of the population is estimated to suffer from impaired glucose tolerance, and indicator of pre-diabetics.

But challenges continue to persist for diabetic care providers, both pharmaceutical companies and medical device manufacturers.

Complex regulatory environments, layered distribution networks, obscure tendering processes, and an unclear understanding of the enormity of the problem as well as what constitutes effective treatment are all contributing to the lackluster treatment of a growing patient base.

By Hiep Nguyen *

* The writer is an analyst at the management consulting firm Solidiance (www.solidiance.com). The opinions expressed are his own.

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