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Type 2 Diabetes Mellitus Therapeutics in Major Developed Markets to 2021 - Strong Pipeline and
Expanding Treatment Population to Encourage Robust Growth
YRH: Type 2 Diabetes Mellitus Therapeutics in Major Developed Markets to
2021 - Strong Pipeline and Expanding Treatment Population to Encourage
Robust Growth
Overview, Size, Share, Analysis, Technology Developments, Development
Status, Trends, Structure, Production Value and Forecast Research Report
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Type 2 Diabetes Mellitus Therapeutics in Major Developed Markets to 2021 - Strong Pipeline and
Expanding Treatment Population to Encourage Robust Growth
Type 2 Diabetes Mellitus Therapeutics in Major Developed Markets to 2021 -
Strong Pipeline and Expanding Treatment Population to Encourage Robust
Growth
Summary:
Type 2 Diabetes Mellitus Therapeutics in Major Developed Markets to 2021 - Strong Pipeline and
Expanding Treatment Population to Encourage Robust Growth
Summary
Type 2 Diabetes Mellitus (T2DM) is a metabolic disease characterized by chronic hyperglycemia (high
blood glucose levels). Global prevalence has risen rapidly in the past several decades, particularly in
line with obesity. This has been attributed to a range of factors, including economic development,
increasing urbanization, aging populations, and changes in lifestyle patterns such as reduced levels
of physical activity and consumption of higher-calorie diets.
This has led to strong commercial interest in the development of T2DM therapeutics. The current
market is large and diverse, comprising several drug classes, including generic and branded drugs.
Owing to the range of therapeutic options available, the treatment algorithm is complex. However,
current treatment regimens are often associated with limited long-term efficacy, complex and
inconvenient dosing regimens, and undesirable side effects such as weight gain and hypoglycemia
(low blood glucose levels).
Scope
- Metformin monotherapy will remain the first-line pharmacotherapy for T2DM.
- The emergence of several new drug classes over the past decade, namely the Glucagon-Like
Peptide-1 (GLP-1) receptor agonists, Dipeptidyl Peptidase 4 (DPP-4) inhibitors, and Sodium–Glucose
Cotransporter 2 (SGLT-2) inhibitors, has led to considerable market growth.

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Type 2 Diabetes Mellitus Therapeutics in Major Developed Markets to 2021 - Strong Pipeline and
Expanding Treatment Population to Encourage Robust Growth
- Which products lead these drug classes and what threats do they face from the pipeline?
- How will the continued uptake of newer drug classes impact established drug classes such as the
sulfonylureas and thiazolidinediones?
- Leading insulin therapy Lantus (insulin glargine) recently lost patent protection in most major
markets.
- Will recently approved insulin therapies such as Tresiba (insulin degludec) and Toujeo (insulin
glargine) be able to capture a significant portion of Lantus’ market share?
- The pipeline is large and highly innovative, comprising a range of molecule types and molecular
targets.
- How do different molecule types and molecular targets compare in terms of average failure rate,
clinical trial duration, and clinical trial size?
- Which late-stage pipeline molecules show the most promise and how will they impact the
treatment algorithm over the forecast period?
- Which late-stage pipeline molecules are expected to generate the highest revenues?
- Over the 2014–2021 forecast period, the global T2DM market is expected to increase in value at a
CAGR of 7.5% from $23.5 billion to $39.0 billion.
- How do prevalence, diagnosis, and treatment patterns vary in the eight major markets?
- Which factors will drive market growth most significantly?
- Strategic consolidation activity in T2DM is considerable, with US-based companies being key
players.
- Do T2DM products tend to attract high levels of investment?
Reasons to buy
- Understand the clinical context of the T2DM indication and the global burden of the disease by
considering epidemiology, symptoms, etiology, pathophysiology, co-morbidities and complications,
disease classification, disease prognosis, and treatment options
- Appreciate the current T2DM marketed products landscape, including the dominant therapeutic
strategies, products, and companies, and recognize gaps within the market and areas of unmet need
- Identify key pipeline trends in molecule type and molecular target
- Recognize the late-stage pipeline molecules that have demonstrated strong therapeutic potential
in T2DM by examining clinical trial data and multi-scenario product forecast projections
- Consider market opportunities and potential risks by examining trends in T2DM clinical trial size,
duration, and failure rate by phase of development, molecule type, and molecular target

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Type 2 Diabetes Mellitus Therapeutics in Major Developed Markets to 2021 - Strong Pipeline and
Expanding Treatment Population to Encourage Robust Growth
- Discern variances in treatment usage patterns, annual therapy costs, and market growth
projections for the US, Canada, the UK, France, Germany, Italy, Spain, and Japan
- Discover how strategic consolidations have shaped the current T2DM pipeline and marketed
products landscapes
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Type 2 Diabetes Mellitus Therapeutics in Major Developed Markets to 2021 - Strong Pipeline and
Expanding Treatment Population to Encourage Robust Growth
1 Table of Contents
1 Table of Contents 4
1.1 List of Tables 7
1.2 List of Figures 7
2 Introduction 9
2.1 Disease Overview 9
2.2 Epidemiology 9
2.3 Symptoms 10
2.4 Etiology 10
2.5 Pathophysiology 11
2.6 Co-morbidities and Complications 13
2.7 Classification 15
2.8 Prognosis 15
2.9 Diagnosis 16
2.10 Assessing Treatment Effectiveness 17
2.11 Treatment Algorithm 17
2.12 Non-insulin T2DM Therapies 19
2.12.1 Biguanides 19
2.12.2 Sulfonylureas and Meglitinides 19
2.12.3 Thiazolidinediones 20
2.12.4 Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists and Dipeptidyl Peptidase 4 (DPP-
4) Inhibitors 20
2.12.5 Sodium–Glucose Linked Transporter-2 (SGLT-2) Inhibitors 21
2.12.6 Other Non-insulin Therapies 21
2.13 Insulin T2DM Therapies 22
2.14 Treatment Segments 24
2.14.1 Non-insulin therapies 24
2.14.2 Insulin Therapies 39
3 Marketed Products 43
3.1 Overview 43
3.2 Biguanides 44
3.2.1 Metformin – Various Companies 44
3.3 Sulfonylureas 45
3.4 Thiazolidinediones 46
3.4.1 Actos (pioglitazone) – Takeda 46

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Type 2 Diabetes Mellitus Therapeutics in Major Developed Markets to 2021 - Strong Pipeline and
Expanding Treatment Population to Encourage Robust Growth
3.5 GLP-1 receptor agonists 47
3.5.1 Byetta (exenatide) – AstraZeneca 47
3.5.2 Bydureon (exenatide) – AstraZeneca 48
3.5.3 Victoza (liraglutide) – Novo Nordisk 49
3.5.4 Tanzeum (albiglutide) – GlaxoSmithKline 50
3.5.5 Trulicity (dulaglutide) – Eli Lilly 51
3.6 DPP-4 Inhibitors 53
3.6.1 Januvia (sitagliptin) – Merck 53
3.6.2 Galvus (vildagliptin) – Novartis 54
3.6.3 Onglyza (saxagliptin) – AstraZeneca 55
3.6.4 Tradjenta (linagliptin) – Boehringer Ingelheim 56
3.6.5 Zafatek (trelagliptin succinate) – Takeda 57
3.7 SGLT-2 Inhibitors 58
3.7.1 Farxiga (dapagliflozin) – AstraZeneca 58
3.7.2 Invokana (canagliflozin) – Janssen 59
3.7.3 Jardiance (empagliflozin) – Boehringer Ingelheim 60
3.8 Insulin Therapies 61
3.8.1 Lantus (insulin glargine) – Sanofi 61
3.8.2 Levemir (insulin detemir) – Novo Nordisk 62
3.8.3 Tresiba (insulin degludec) – Novo Nordisk 63
3.8.4 Toujeo (insulin glargine) – Sanofi 63
3.9 Marketed Products Heat Maps 64
4 Pipeline 67
4.1 Overview 67
4.2 Pipeline Distribution by Stage of Development, Molecule Type and Program Type 68
4.3 Pipeline Distribution by Molecular Target 71
4.4 Clinical Trial Landscape 78
4.4.1 Clinical Trial Failure Rates 78
4.4.2 Clinical Trial Duration 83
4.4.3 Clinical Trial Size 86
4.5 Promising Pipeline Molecules 91
4.5.1 Omarigliptin – Merck 91
4.5.2 NN-9535 (semaglutide) and OG-217SC (semaglutide) – Novo Nordisk 92
4.5.3 ITCA 650 – Intarcia Therapeutics 94
4.5.4 LX-4211 (sotagliflozin) – Lexicon Pharmaceuticals 96
4.5.5 Insulin peglispro – Eli Lilly and Company 98
4.5.6 ISIS-GCGRRx – Isis Pharmaceuticals 100
4.5.7 BSN-175 (D-Tagatose) – Biospherics.net Incorporated 102
4.6 Pipeline Products Heat Map and Competitive Product Framework 103
5 Market Forecast to 2021 106
5.1 Geographical Markets 106
5.2 Global Markets 106
5.3 North America 109
5.3.1 Treatment Usage Patterns 109
5.3.2 Annual Cost of Therapy 111
5.3.3 Market Size 112

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Type 2 Diabetes Mellitus Therapeutics in Major Developed Markets to 2021 - Strong Pipeline and
Expanding Treatment Population to Encourage Robust Growth
5.4 Top Five European Markets 114
5.4.1 Treatment Usage Patterns 114
5.4.2 Annual Cost of Therapy 116
5.4.3 Market Size 117
5.5 Japan 118
5.5.1 Treatment Usage Patterns 118
5.5.2 Annual Cost of Therapy 118
5.5.3 Market Size 119
5.6 Drivers and Barriers for the T2DM Therapeutics Market 120
5.6.1 Drivers 120
5.6.2 Barriers 121
6 Strategic Consolidations 122
6.1 Licensing Deals 122
6.1.1 Sanofi Enters into Licensing Agreement with MannKind for Afrezza 127
6.1.2 Array BioPharma Enters into a Licensing Agreement with Amgen – Now Terminated
128
6.1.3 Emisphere Technologies Enters into a Licensing Agreement with Novo Nordisk 128
6.1.4 Eli Lilly Enters into Licensing Agreement with Adocia 128
6.1.5 Depomed Enters into a Licensing Agreement with Merck 129
6.2 Co-development Deals 129
6.2.1 Intarcia Therapeutics Enters into Co-Development Agreement with Les Laboratoires
Servier for ITCA 650 (exenatide) 136
6.2.2 Merck Enters into Co-Development Agreement with Pfizer for PF-04971729
(ertugliflozin) 137
6.2.3 Eli Lilly Enters into a Co-development Agreement with Boehringer Ingelheim 137
6.2.4 Amylin Pharma Terminates Co-development Agreement with Eli Lilly for Exenatide 137
6.2.5 AstraZeneca Enters into Co-development Agreement with Bristol-Myers Squibb 138
6.2.6 Neurocrine Biosciences Enters into a Collaboration Agreement with Boehringer
Ingelheim 138
7 Appendix 139
7.1 All Pipeline Drugs by Phase of Development 139
7.1.1 Discovery 139
7.1.2 Preclinical 142
7.1.3 IND/CTA-filed 150
7.1.4 Phase I 151
7.1.5 Phase II 153
7.1.6 Phase III 156
7.1.7 Pre-registration 157
7.2 Market Forecasts to 2021 158
7.2.1 Global 158
7.2.2 US 158
7.2.3 Canada 158
7.2.4 UK 159
7.2.5 France 159
7.2.6 Germany 159
7.2.7 Italy 160

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Type 2 Diabetes Mellitus Therapeutics in Major Developed Markets to 2021 - Strong Pipeline and
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7.2.8 Spain 160
7.2.9 Japan 160
7.3 References 161
7.4 References for Heat Maps 171
7.4.1 Marketed Products Heat Map 171
7.4.2 Pipeline Heat Map 172
7.5 Abbreviations 173
7.6 Research Methodology 175
7.7 Secondary Research 175
7.8 Marketed Product Profiles 176
7.9 Late-Stage Pipeline Candidates 176
7.10 Comparative Efficacy and Safety Heat Map for Marketed and Pipeline Products 176
7.11 Product Competitiveness Framework 176
7.12 Pipeline Analysis 177
7.12.1 Overall Pipeline 177
7.12.2 Clinical Trials 177
7.12.3 Failure Rate 177
7.12.4 Clinical Trial Size 177
7.12.5 Clinical Trial Duration 177
7.12.6 Clinical Trial Endpoint Analysis 177
7.13 Forecasting Model 178
7.14 Deals Data Analysis 179
7.15 Expert Panel Validation 179
7.16 Contact Us 179
7.17 Disclaimer 179
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Type 2 Diabetes Mellitus Therapeutics in Major Developed Markets to 2021 - Strong Pipeline and
Expanding Treatment Population to Encourage Robust Growth
Table of Figures:
1.1 List of Tables
Table 1: Dose Levels for Groups Initially Receiving Metformin in Combination with Glyburide,
Metformin Monotherapy and Glyburide Monotherapy 27
Table 2: T2DM Therapeutics Market, Global, Breakdown of Multiple Molecular Targets, 2015 76
Table 3: T2DM Therapeutics Market, Global, Breakdown of ‘Other’ Molecular Targets, 2015 77
Table 4: T2DM Therapeutics, Global, All Pipeline Products, Discovery Phase, 2015 139
Table 5: T2DM Therapeutics, Global, All Pipeline Products, Preclinical Phase, 2015 142
Table 6: T2DM Therapeutics, Global, All Pipeline Products, IND/CTA-filed Phase, 2015 150

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Type 2 Diabetes Mellitus Therapeutics in Major Developed Markets to 2021 - Strong Pipeline and
Expanding Treatment Population to Encourage Robust Growth
Table 7: T2DM Therapeutics, Global, All Pipeline Products, Phase I, 2015 151
Table 8: T2DM Therapeutics, Global, All Pipeline Products, Phase II, 2015 153
Table 9: T2DM Therapeutics, Global, All Pipeline Products, Phase III, 2015 156
Table 10: T2DM Therapeutics, Global, All Pipeline Products, Pre-registration Phase, 2015 157
Table 11: T2DM Therapeutics Market, Global, Market Forecast, 2014–2021 158
Table 12: T2DM Therapeutics Market, US, Market Forecast, 2014–2021 158
Table 13: T2DM Therapeutics Market, Canada, Market Forecast, 2014–2021 158
Table 14: T2DM Therapeutics Market, UK, Market Forecast, 2014–2021 159
Table 15: T2DM Therapeutics Market, France, Market Forecast, 2014–2021 159
Table 16: T2DM Therapeutics Market, Germany, Market Forecast, 2014–2021 159
Table 17: T2DM Therapeutics Market, Italy, Market Forecast, 2014–2021 160
Table 18: T2DM Therapeutics Market, Spain, Market Forecast, 2014–2021 160
Table 19: T2DM Therapeutics Market, Japan, Market Forecast, 2014–2021 160
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Type 2 Diabetes Mellitus Therapeutics in Major Developed Markets to 2021 - Strong Pipeline and
Expanding Treatment Population to Encourage Robust Growth
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