Funding Diabetes Research

April 2014
Are Regional Output and Funding Matching the Global Burden?

Upwards of 382 million people around the world are living with diabetes, according to the International Diabetes Federation (IDF). During 2013, the disease killed 5.1 million people—half of them under the age of 60. The worldwide incidence of diabetes continues to rise, with associated health-care costs estimated at US$ 471 billion in 2012 alone.

To look more closely at selected aspects of diabetes research, ScienceWatch turned to the Web of Science for measures of research output as well as for exclusive Thomson Reuters data on funding.

These figures are reflected in the accompanying table and graphic.

Since August of 2008, Thomson Reuters has recorded funding acknowledgements from the papers it indexes for the Web of Science. In addition to the name of the organization listed as a source of support, grant numbers are also captured (if given), as well as the acknowledgement paratext that provides further details of financial and other types of assistance.

The presence of funding acknowledgements in the database allows research inputs (financial support) to be linked, at the paper level, with research outputs (publications) and their impacts (measured by citation counts). The analysis of such linkages is complicated for several reasons: papers may and often do mention multiple funders, and different papers may acknowledge the same grant from the same funder. Also, authors who receive a grant may neglect to acknowledge this funding source in their papers. Despite these complexities, various analyses are now possible that could not be attempted previously, since one-by-one, manual look-ups were typically needed to obtain the input-output data at the paper level.

To cull pertinent literature devoted to diabetes, ScienceWatch searched the Web of Science between January 2008 and July 2013 for papers on “diabetes” and related terms. From the resulting selection of roughly 200,000 reports, ScienceWatch identified the explicitly acknowledged funding agencies that were associated with the greatest numbers of papers.

Prominent Funders of Diabetes Research,

(Ranked by number of papers in which each funding entity is expressly acknowledged)

Rank Funding Agency Papers Percent
1 US National Institutes of Health (Institute not specified) 13,436 6.40
2 National Natural Science Foundation of China 3,354 1.60
3 JDRF (US) 2,547 1.21
4 US National Institute of Diabetes and Digestive and Kidney Diseases 2,527 1.20
5 Canadian Institutes of Health Research 2,281 1.09
6 Novo Nordisk 2,170 1.03
7 Ministry of Education, Culture, Sports, Science and Technology of Japan 2,042 0.97
8 US National Heart Lung and Blood Institute 1,850 0.88
9 American Diabetes Association 1,700 0.81
10 Pfizer Inc. 1,548 0.74
11 National Health and Medical Research Council of Australia 1,443 0.69
12 European Union 1,435 0.68
13 German Research Foundation 1,302 0.62
14 Eli Lilly 1,282 0.61
15 Sanofi Aventis 1,247 0.59
16 Novartis 1,230 0.59
17 Merck/MSD 1,192 0.57
18 American Heart Association 1,174 0.56
19 US National Center for Research Resources 1,151 0.55
20 Wellcome Trust (UK) 1,127 0.54
21 US National Institute on Aging 1,058 0.50
22 AstraZeneca 1,018 0.48
23 Swedish Research Council 991 0.47
24 GlaxoSmithKline 975 0.46
25 CNPQ (Brazil) 789 0.38
26 Medical Research Council (UK) 762 0.36
27 Bristol Myers Squibb 741 0.35
28 Japan Society for the Promotion of Science 723 0.34
29 Takeda Pharmaceutical Company Ltd. 717 0.34
30 Swiss National Science Foundation 613 0.29
31 Roche 606 0.29
32 National Science Foundation (US) 573 0.27
33 European Commission 571 0.27
34 National Basic Research Program of China 568 0.27
35 Academy of Finland 566 0.27
  British Heart Foundation 566 0.27
SOURCE: Thomson Reuters Web of Science

As the list makes plain, the US National Institutes of Health (NIH) stands apart in funding diabetes research. Between papers that list NIH support without mentioning a specific institute, and those that specify the National Institute of Diabetes and Digestive and Kidney Diseases and other component agencies, the NIH is acknowledged on roughly 20,000 papers—or 10% of the total identified for this study.

The rest of the list provides a mix of national agencies along with such global pharmaceutical heavyweights as Novo Nordisk, Pfizer, Eli Lilly, Takeda, GlaxoSmithKline, and others.

Among nations, China is represented at the top and the bottom of the list, with the National Natural Science Foundation (#2) and the National Basic Research Program (#34). Given that, according to IDF figures, some 98 million people between the ages of 20 and 79, out of China’s population of 1.3 billion, are living with diabetes, the appearance of these agencies is fitting.

Notably absent among the listed bodies is any sign of funding agencies in some regions of the world where diabetes is serious and increasing. In India, for example, IDF figures indicate that 65 million of the country’s population of 1.2-billion people are afflicted. Among papers that explicitly acknowledge India-based funding sources, the Indian Council of Medical Research is comparatively well represented, accounting for some 250 papers, although not reaching a level sufficient to register among the top agencies listed here.

Incidence is also particularly high in Indonesia and other Asia Pacific nations, where 1 in 3 adults has diabetes. Similarly, Middle East nations such as Saudi Arabia, Kuwait, and Bahrain also show high concentrations of the disease. And in Africa, the region with the highest mortality due to diabetes, an estimated 20 million people are living with the condition—a number expected to double in the next 20 years—and up to 80% of cases are undiagnosed. Again, however, despite these burdens, no agencies from these regions have yet emerged among the most active funders as indexed by Thomson Reuters.

The accompanying graphic, combining Thomson Reuters data with the statistics on regional incidence presented in the IDF Diabetes Atlas, underscores this impression of imbalance. The display for each region includes figures from the Web of Science showing the collective output of diabetes-related papers indexed by Thomson Reuters between 2008 and July 2013.

View the Infographic

Each region’s representation among the listing of 35 prolific funding agencies is conveyed by a “building” icon that shows how many of these major funders are located in the given region. As noted above, Africa, the Middle East/North Africa, and Southeast Asia still lag the world in this regard.

In output of research papers between 2008 and 2013, as with the presence of prolific funding agencies, Europe and the North America/Caribbean region are distinct in their prominence, each accounting for roughly 80,000 reports. (Due to international collaboration, the counts for the respective regions do reflect some overlap—for example, papers listing both European and North American institutional affiliations would be credited equally to both regions.)

The Asia Pacific region contributed to more than 47,000 diabetes papers during the last five years. This is a substantial quantity but, given the 138 million afflicted in the region, the density of research (i.e., number of papers per million of people with the condition) is clearly below that in Europe and North America.

Similar disparities, between disease burden and research output, are evident in the remaining regions, especially glaringly in Africa and, above all, in the IDF grouping for Southeast Asia. The latter’s output of 5,900 papers (roughly 5,600 of them listing author addresses in India) contrasts starkly with an affected population numbering 72 million.

In all, these figures suggest that, in the face of a growing worldwide burden of diabetes, there are regional imbalances in the funding and production of research.

Nevertheless, investment in diabetes research is showing results. For the years 2008 to 2013, a review in Thomson Reuters IntegritySM, a database of drug research and development, recorded more than 10,000 records of patent filings for discovery compounds or drugs under development, with more than 375 drugs currently active in the pipeline, and more than 130 treatments in phases II and III

The Integrity study identified the top molecular targets under investigation for the diabetes during this period. One such target is DPP-4, an enzyme whose actions affect peptides involved in the regulation of blood glucose levels. Agents that inhibit DPP-4 prolong the activity of these peptides in regulating insulin secretion and other processes, resulting in lower levels of blood glucose. Other current molecular targets include PPAR gamma (involved in fat storage and glucose metabolism), GLP-1 (insulin and glucagon secretion, among other processes), and SGLT-2 (glucose transport and reabsorption).

Thus, as this snapshot of diabetes research activity attests, recent years have seen substantial activity and progress, even while the growing incidence presents an ongoing, global challenge.

The data and citation records included in this report are from Thomson Reuters Web of ScienceTM. Web of ScienceTM is a registered trademark of Thomson Reuters. All rights reserved.