Intended for healthcare professionals

Feature Diabetes

How small changes led to big profits for insulin manufacturers

BMJ 2010; 341 doi: (Published 15 December 2010) Cite this as: BMJ 2010;341:c7139
  1. Deborah Cohen, investigations editor1,
  2. Philip Carter, journalist2
  1. 1BMJ, London WC1H 9JR, UK
  2. 2London
  1. dcohen{at}

In the first of a series of investigations by the BMJ and Channel 4 News, Deborah Cohen and Philip Carter discover why more expensive analogue insulins are increasingly prescribed instead of cheaper human insulin despite lack of evidence of benefit for patients with type 2 diabetes

Diabetes is a market worth fighting for—it’s the fourth biggest global therapeutic class, generating total sales in 2009 of $30.4bn (£19bn; €23bn).1 In the UK alone, diabetes is estimated to cost the NHS some £9bn—about 10% of its entire budget.2

In May 2010, Sanofi-aventis briefed investors in London on the emerging opportunity.3 The company stated that diabetes remains one of the largest growth opportunities in healthcare and one of the fastest growing markets—outstripping growth in the wider drug market by 5% a year for the past six years. It was, said the company, destined to grow to €50bn by 2015. Sanofi laid out the scale of its ambitions clearly: to be the number one firm in the diabetes market.3 4

The growth in diabetes drug revenue has been caused in part by rising numbers of people with diabetes; partly by more aggressive approaches to glucose lowering; but mainly by increasing unit costs for insulin5—a cost that can be attributed to the use of more expensive recombinant insulin analogues.

Sanofi’s ambition to be, in effect, the dominant force means wresting control from the traditional heavyweights of the insulin world, Novo Nordisk and Eli Lilly. However, health services and individuals across the world are paying the price for this market drive, which has seen more expensive analogue insulins taking the place of cheaper human insulin.

Added value?

Insulin comes in different forms: short acting, basal (intermediate and long acting), and a mixture of the two types called biphasic insulin. Each of these …

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