Diben 1,5 Kcal HP Detailed-Training Aug2014-Final

The newest member of the Diben family
Diben 1,5 kcal HP

For better glycaemic control
© Copyright Fresenius Kabi Deutschland GmbH 1

Content
 Prevalence of diabetes
 iabetes market data & FK Sales
 Why a disease specific formula?
 Key product information:
- Presentation, article codes and shelf life
- Target patient group & positioning
- Key product features
- Energy distribution and sources
- Nutrient profile
 How does Diben 1,5 kcal HP match with international recommendations?
 Features and benefits
 USP & Key message
 Diben range comparison
 Competitor comparison
 Promotional support
Content
 Prevalence of diabetes
 Diabetes market data & FK Sales and FC
 Why a disease specific formula?
 Key product information:
- Presentation, article codes and shelf life
- Target patient group
- Key product features
- Energy distribution and sources
- Nutrient profile
 How does Diben 1,5 kcal HP match with international recommendations?
 Features and benefits
 USP & Key message
 Diben range comparison
 Competitor comparison
 Promotional support
Number of diabetics worldwide
Source: IDF Diabetes Atlas, 6th ed., 2013

2013 and 2035
AFR: Africa;
MENA: Middle East and North Africa;
SEA: South-East Asia;
SACA: South and Central America;
WP: Western Pacific
NAC: North America and Caribbean;
EUR: Europe;

Highest number of diabetic patients in Western
Pacific (incl. China), South East Asia, Europe

Top 10 countries/territories for prevalence* (%)
of diabetes (20-79y) 2013

Number of diabetics (20 -79 y) in 2013
Top 10 countries

Impaired glucose metabolism
in the elderly & in hospital settings
Diabetes mellitus is a common disease among

the elderly
~50% of type 2 diabetic patients are > 60 years
Prevalence of diabetes in hospitalized patients:

- Among all patients: 15%
- In patients >64 years: 30%
Prevalence of hyperglycaemia in hospitalized

patients: 38 %
Morley, J.E. Diabet Med, 1998. 15 Suppl 4: S41-6

Carral F. et al. Dibetes Res Clin Pract, 2003. 59 (2): 145-51
Umpierrez G.E. et al. J Clin Endocrinol Metab 2002, 87 (3): 978-82
Conclusion
 382 million people have diabetes in 2013; by 2035 this will rise to 592 million
 The number of people with type 2 diabetes is increasing in every country
 Almost 50% of type 2 diabetic patients are > 60 years of age
 Prevalence of diabetes in hospital settings: 15 - 30%
Prevalence hyperglyceamia in hospital settings up to 38%

Diabetes EN market 2011
Net Sales: 168 mio € +15% growth vs PY*

3,5 % of total EN
Source: WMD 2012

* Constant exchange rate

Diabetes market 2011
EN sales by competitor
Source: WMD 2012,

Diabetes market 2011
EN sales in Top 10 markets

Diabetes tube feed market 2011
TF sales by competitor
Net Sales: 84,5 mio € +14,8% growth vs PY*

4,3 % of total TF sales
Source: WMD 2012


Diabetes tube feed market 2011
TF sales in Top 10 markets
Net Sales: 84 mio € +14,8% growth vs PY*
Source: WMD 2012

Fresenisu Kabi
Diabetes Range Development
Net Sales: 47 mio € +3% growth vs PY

12,7 % of total EN sales
Diabetes TF sales:
16,6% of total TF sales
Source: Applix,
Incl. Diben/ DRINK, Fresbind diabetes,
Fresubin DB control / DRINK, w/o

Diben 1,5 kcal HP
Forecast / IO situation
Forecast (according IOs) :

500 ml
Year 1*: 65 000 Unit / 370 000 Euro
Year 3°: 200 000 Units / 1 120 000 Euro
1000 ml
Year 1*: 10 000 Unit / 63 000 Euro
Year 3°: 60 000 Units /380 000 Euro
IOs are given from:

Belgium, Brazil, Chile, Egypt, Greece, Ireland, Norway, Peru, Poland,
Portugal, Slovenia, South Africa, Spain, Sweden, Switzerland, Turkey
Additionally interested, evaluating launch:

Austria, France, Germany, Hungary, Taiwan
* According IO, °According NPC

Product for impaired glucose metabolism
The overall target
The ultimate goals for the

management of impaired glucose
metablism are:
 Stabilize a positive lipid status
 to minimize blood glucose

fluctuations

Why a disease specific formula?
“diabetes-specific formulas are

associated with improved
glycemic control compare with
standard formulas”
Elia M. et al. Diabetes Care 2005 Sep;28(9):2267-79

How should a diabetes- specific formula
look like?
Nutritional
Rational
Recommendation
Low SFA Improve lipid control
High MUFA Reduce cardiovascular risk
With DHA & EPA from fish oil Enhance glycaemic control
Improve glycaemic control

Low GI
Reduce insulin requirement
Reduce oxidative stress

Meet RDA for micronutrients
Improve insulin sensitivity
Reduce diarrhoea and

Meet RDA for fibre
constipation
Ley SH et al: Lancet (2014) 383(9933):1999-2007. Gonzalez-Campoy JM, et al: Endocrine

practice : official journal of the American College of Endocrinology and the American
Association of Clinical Endocrinologists (2013) 19(5):875-887. Evert AB, et al: Diabetes care
© Copyright Fresenius Kabi Deutschland GmbH (2013) 36(11):3821-3842. 20
Diben 1,5 kcal HP
Presentation, article codes and shelf life
 500 ml EasyBag:
article code 7111221 - D-GB-F-P-NL
article code 7200221 - E-S-N-PL-SI
 1.000 ml EasyBag:
article code 7111231
language combination not yet defined
(available as of 2015)
 Shelf life:
- at launch 9 months
- as soon as sufficient stability data is available the shelf life
will be extended to 12 months

Diben 1,5 kcal HP
Product description and main target group
Nutritionally complete, high-caloric,

high protein tube feed with a nutrient-
adapted formulation specifically designed
for patients with or at risk of malnutrition
and impaired glucose metabolism
such as in
 Impaired glucose tolerance
 Stress-induced hyperglycaemia
 Diabetes mellitus

Diben 1,5 kcal HP
FK enteral portfolio for impaired glucose metabolism
Tube Feed
• Normo-caloric: Diben
(Fresubin DB control)
Fresubin diabetes
• High-caloric/High protein: Diben 1,5 kcal HP
ONS
• High-caloric / High protein: Diben Drink
(Fresubin DB control DRINK)
• High-caloric / High protein: Diben Creme
(Fresubin DB control DRINK)
Powder
• Normo-caloric: Diben Powder

Diben 1,5 kcal HP
Product key features
Excellent fat profile

High in protein
Rich in DHA and EPA….. USP
75g/1000ml  20 en%
High in MUFA and low in SFA
100% milk protein
With MCT
Low n6:n3 ratio of 2.4 : 1
High-caloric
1.5kcal/ml
Balanced fibre mix
including prebiotic
inulin
Modified carbohydrate
profile
With slowly released Low in sodium
carbohydrates
For low GI
Increased in Chromium

Diben 1,5 kcal HP
Nutrient sources
Nutrients Nutrient source
Protein Milk
Fat Sunflower oil, rapeseed oil, MCT oil, soy oil, fish oil
Carbohydrate Tapiocadextrin, maltodextrin, isomaltulose, fructose
Fibre Tapioca fibre, cellulose, inulin

Nutrient profile – Diben 1,5 kcal HP
HV1127: Main Nutrients
Average content: per 100 ml RDD = 1.000 ml
Energy 630 kJ 6.300 kJ

(= 150 kcal) (= 1.500 kcal)
Protein 20 en % 7.5 g 75.0 g
Fat 42 en % 7.0 g 70.0 g
of which MCT 7 en % 1.2 g 12.0 g
of which saturated fatty acids 4 en % 0.62 g 6.2 g
of which MUFA 22 en % 3.68 g 36.8 g
of which PUFA 9 en % 1.50 g 15.0 g
of which EPA + DHA 0.23 g 2.3 g
Carbohydrate 35 en % 13.1 g 131 g
of which oligo- and polysaccharides 3.4 g 34.0 g
of which starch 2.7 g 27 g
of which sugars 7.0 g 70 g
of which fructose 1.5 g 15.0 g
of which lactose ≤0.48 g ≤4.8 g
Fibre 3 en % 2.3 g 23 g
Water 79 ml 790 ml
Osmolarity 450 mosmol/l

HV1127: Minerals and trace elements
Sodium 55 mg 550 mg
Potassium 180 mg 1800 mg

Chloride 85 mg 850 mg
Calcium 155 mg 1550 mg
Magnesium 30 mg 300 mg
Phosphorus 110 mg 1100 mg
Iron 2.0 mg 20 mg
Zinc 1.8 mg 18 mg
Copper 200 µg 2000 µg
Manganese 0.4 mg 4 mg
Iodide 20 µg 200 µg
Fluoride 0.2 mg 2 mg
Chromium 20 µg 200 µg
Molybdenum 15 µg 150 µg
Selenium 10 µg 100 µg

HV1127:Vitamins and other substances
Vitamin A 0.11 mg 1.1 mg
ß-Carotene 0.2 mg 2 mg
Vitamin D3 2.0 µg 20 µg
Vitamin E 2.3 mg 23 mg
Vitamin K1 10 µg 100 µg
Vitamin B1 0.2 mg 2.0 mg
Niacin 2.4 mg 24 mg
Vitamin B12 0.40 µg 4.0 µg
Pantothenic acid 0.7 mg 7.0 mg
Biotin 7.5 µg 75 µg
Folic acid 40 µg 400 µg
Vitamin C 12 mg 120 mg
Choline 55 mg 550 mg

Diben 1,5 kcal HP – Optimal nutrition
for patients with impaired glucose metabolism
International Diabetes Recommendations:

“Substituting MUFA for SFA has beneficial effects on serum lipid levels
and on lipoprotein concentration and composition, and also on insulin
sensitivity
Substituting MUFA for carbohydrates may also confer some benefit

regarding serum lipid levels”
The praised to MUFA:

 ADA1: Beneficial effects in glucose control &
lipid levels
 EASD2: beneficial effects in serum lipids
1) Evert A. B. et al. Diabetes Care 2013 Nov.; 36(11): 3821-42.

2) Mann J.I. et al. Nutr Metab Cardiovasc Dis 2004; 14: 373–394.

Main substrates EASD 2004 ADA 2013°
Protein 10 – 20 en% -*) 20 en%
Carbohydrates 45 – 60 en% -*) 35 en%
Ideally > 40g/day or

Dietary fibre
20g/1000kcal/day
≥ 14g/1000kcal 15.3 g/1000 kcal
Fructose < 30 g/day Max. 12 en% 4 en%; 15g/RDD
Sodium < 2300 mg / day 550 mg / RDD
° ADA 2013 : The best macronutrient mix “appears to vary depending on individual circumstances”, “total caloric intake must be
appropriate to weight management goals” & “will depend on the metabolism status of the patient” (e.g. lipid profile).
-*) Not fixed recommendations

Main substrates EASD 2004 ADA 2013
FAT ≤ 35 en% §) Quality more important

than quantity
10 en% or < 8en% when

SFA < 10 en% 4 en%
LDL cholesterol is elevated
MUFA 10-20 en% - *) 22 en%
PUFA ≤ 10 en% - *) 9 en%
MCT With MCT With MCT
Cholesterol ≤ 300 mg < 200 mg < 100 mg
With EPA + DHA

Fish oil
from fish oil
With EPA + DHA
-*) Not fixed recommendations.

§) Recommendations for the dietary management of obese people.
Not referred to MCT fat
Diben 1,5 kcal HP
Key features and benefits
High energy density (1.5 kcal/ml)
 To meet the energy requirements

in a low volume

Diben 1,5 kcal HP
High protein quantity & quality

High in protein (20en% = 75 g /l)
 to support protein intake
 to support protein anabolism
 To prevent protein deficiency
High quality (100% milk protein)

 to meet the requirements for all essential
amino acids

Diben 1,5 kcal HP
High protein quality
120 –
100 –
80 –
60 –
█ Diben 1,5 kcal HP mg/g protein

Penylalaninbe + Tyrosine
40 –
█ WHO/FAO Reference Amino acid pattern
mg/g protein
20 –
Methionine
Tryptopan
Threonine
Isoleucine
Histidine
Cysteine
Leucine
Lysine
Valine
0–

Diben 1,5 kcal HP
Modified carbohydrate profile
With Isomaltulose
slowly digested and absorbed in the small intestine
 To counteract high postprandial glucose
 To minimize blood glucose fluctuations
 To ensure a low glycaemic index (GI = 22)*
*the glycaemic index of Diben 1,5 kcal HP was measured according to the standard in
vivo FAo/WHo method and has a value of 22 which is defined as low.
Definition (FAo/WHo):
low: GI ≤ 55, medium: Gi = 56—69, High: Gi ≥ 70

Diben 1,5 kcal HP
Benefits of Isomaltulose
High GI
No relative
hypoglyceamia Steady and longer
Low GI engery supply
Decrease of blood
glucose level below
initial value
www.beneo-palatinit.com
Diben 1,5 kcal HP
With EPA and DHA from fish oil
 To lower plasma triglycerides3

 To improve glucose control and insulin activity
 To reduce inflammation and oxidative stress
 lowering the risk of cardiovascular disease
3Miller M. et al. Circulation 2011; 123: 2292-2333.

Diben 1,5 kcal HP
High in Monounsaturated fatty acids (MUFA)

22 en% = 36.8 g / l
 To improve:
- glycaemic control4
- dyslipidemia5
- insulin sensitivity4
4)Schwingshackl L. et al. Ann Nutr Metab 2011; 58:290–296.

5) Paniagua J.A. et al. Diabetes Care 2007; 30 (7): 1717-1723.
Diben 1,5 kcal HP
High in Monounsaturated fatty acids (MUFA)

Studies with Diben and Diben DRINK showed significantly
improved long term glycaemic control compared to standard
feeds6,7
6) Pohl M, et al: Journal of Parenteral and Enteral Nutrition, 2009;33 (1):37-49

7) Mayr P, et al: Poster ESPEN 2013

Diben 1,5 kcal HP
Cardio healthy fat composition
High in MUFA (22en%)

Rich in fish oil (2.3 g/l)
Low in SFA (4en%)
Low n6:n3 ration (2.4:1)
No Trans-Fatty acids
 To reduce the risk of developing

cardiovascular disease8
 To reduce the risk of complications of impaired
glucose metabolism
8) Miller M. et al. Circulation 2011; 123: 2292-2333.

Diben 1,5 kcal HP
Cardio healthy fat composition
ADA Recommendation (2013) says:
„In people with type 2 “Increase in foods containing

diabetes, a Mediterranean- EPA, DHA and ALA is
style, MUFA-rich eating recommended for individuals
pattern may benefit with diabetes…
glycemic control and CVD → beneficial effects on
risk factors and can lipoproteins, prevention of
therefore be recommended as heart disease,
an effective alternative to a associations with positive
lower-fat, higher-carbohydrate health outcomes in
eating pattern“ observational studies”

Diben 1,5 kcal HP
With Medium chain triglycerides

 To contribute to better lipid control9,10
 Easily absorbed source of energy
9)Miller M. et al. Circulation 2011; 123: 2292-2333.

10) Hauenschild A. et al. Ann Nutr Metab 2010; 56: 170-175.
Effects of different types of dietary fat on
insulin resistance and lipid profiles: MCTs
LCTs and MCTs are

metabolised different:
Triglyceride
LCTs are absorbed via levels
the intestinal lymphatic in blood
ducts and transported
in chylomicrons into the
systemic circulation.
LCT
MCTs are hydrolysed
and transported to the MCT
liver via the portal vein
where they are rapidly
oxidised to ketones.
Aoyama T et al, The journal of medical

investigation : JMI (2007) 54(3-4):385-388.

Diben 1,5 kcal HP
Increased Chromium (200 µg/l )

 To contribute to improve insulin sensitivity
and improve glucose metabolism

Diben 1,5 kcal HP
Chromium
Necessary for normal glucose tolerance and lipid metabolism
 ability to potentiate the actions of insulin in facilitating
cellular uptake of glucose
CEFALU, W.T. ,DIABETES CARE, 2004. Volume 27, No 11

Diben 1,5 kcal HP
Chromium
Supplementation in patients with glucose intolerance and
diabetes
 increase insulin sensitivity and improve glucose metabolism
CEFALU, W.T. ,DIABETES CARE, 2004. Volume 27, No 11

Diben 1,5 kcal HP
With a fibre mixture
including prebiotic inulin
Normalisation of stool frequency and

consistency to avoid diarrhoea or
constipation
 To support healthy gut function
 To ensure a good intestinal tolerance

Diben 1,5 kcal HP
With a fibre mixture
© Copyright Fresenius Kabi Deutschland GmbH

For references refer to scientific rationale 48
Diben 1,5 kcal HP
Low in Sodium
 To meet the needs of hypertesive patients

Diben 1,5 kcal HP
Low in Sodium
ADA Recommendation (2013) says:
„The recommendation for the general

population reduce sodium to
less than 2300 mg/day is also
appropriate for people with daibetes.
For individuals with both diabetes and
hypertension, further reduction in
sodium intake should be
individualized.“

Diben 1,5 kcal HP
Nutritionally complete
in 1000 ml = 1500 kcal
 to provide all nutrients in a low volume
 to be suitable for patients in need of
volume restriction

Diben 1,5 kcal HP
Dosage Recommendation:
500 ml volume water energy protein

EasyBag
supplemental 1 500 ml 395 ml 750 kcal 42 g
nutrition
complete 2 1000 ml 790 ml 1500 kcal 37.5 g
nutrition

Diben 1,5 kcal HP
Two bag sizes available

500 ml and 1000 ml EasyBag
 to meet individual needs

USPs
USP in the range of high caloric (> 1.2 kcal/ml)

diabetes tube feeds:
Contains EPA and DHA from fish oil

- Contributes to healthy blood lipid levels
- and to protection from cardiovascular disease
USP in the field of high caloric diabetes products with

1.5 kcal/ml:
Contains MCT
- Improves tolerance
- and contributes to blood lipid control

Key Messages
Diben 1.5 kcal HP – for nutritional management

beyond glycaemic control
High in MUFA
and modified EPA and DHA
With MCT from fish oil to
Providing carbohydrate profile
to contribute to contribute to
concentrated is
blood lipid control
nutrition improving the healthy blood lipid
and
in a metabolic situation levels and
good intestinal
low volume of patients with help to protect from
tolerance
impaired glucose cardiovascular
metabolism disease

Enteral Diabetes Range - comparison
Kcal/ml 1,5 1,0 1,5 1,5 1,0
Protein (en%) 20 17 20 20 18
High in MUFA With MUFA
EPA+DHA / fish oil -- --
Modified CHO
Chromium Increased High With With High
Green-tea extract -- -- --

Main competitor products
Glucerna 1.5 kcal Glucerna (HiCal) Novasource Diabet Plus

EU US EU
1.5 kcal/ml 1.2 and 1.5 kcal/ml
1.2 kcal/ml

Complete Competitor product overview
Fresenius Kabi Abbott Nestlé
Int D Spain US US Spain Spain Sweden US
Novasource® DIABET
Diben 1.5 kcal HP Glucerna® HiCal Glucerna 1.5 Glucerna® 1.5 Cal Glucerna® 1.2 Cal Glucerna 1.2 Novasource DIABET PLUS Diabetisource AC
PLUS
Presentation EB: 500ml, 1.000ml plastic bottle: 500ml plastic bottle: 500ml, 220ml plastic bottle: 1000ml can: plastic bottle: 1000ml, plastic bottle: 500ml glass: 500ml glass: 500ml container: 1000ml, 1500ml
237 ml 1500ml, can: ultrapak, 250ml tetrapak
237 ml
Flavours neutral vanilla vanilla neutral neutral vanilla Vanilla, Dry Fruits vanilla neutral
Caloric Distribution (P:F:CHO) 20:42:35:3 20:45:32,7 22:45:33 20:45:35 20:45:35 20:39:39 20:40:40 20:44:36
Energy density (kcal/ 100ml) 150 150 150 150 120 120 1,23 120 120
Daily Dosage (l/ kcal) 1000ml/1500kcal 1 - 1,5/1500-2250 1,5l/1800 1,25/1500

Protein (g/ 100ml) 7,5 7,5 7,5 8,25 6 6 6 6 6
Fat (g/ 100ml) 7 7,5 7,5 7,5 6 6 5,32 5,3 6
CHO (g/ 100ml) 13,1 13 12,95 13,31 11,45 10,29 12 12 10
Protein sources Ca-caseinate, Na- Na- and Ca-caseinate Na-caseinate, soy protein Casein milk soy protein, L‐arginine
caseinate, soy protein isolate, milk protein
isolate concentrate
milk
Fat sources sunflower oil, rapeseed oil, canola oil, high oleic high oleic safflower oil, high oleic safflower oil, veg. Oils, MCT veg. Oils, MCT canola oil, refined fish oil
MCT oil, soy oil, fish oil sunflower oil, glycerin, canola oil, glycerin canola oil, soy lecithin
lecithin
SFA (g/ 100ml) 0,62 (4 en%) 0,57 0,58 4 en% of total cal 0,49 1,2
MUFA (g/ 100ml) 3,68 (22 en %) 4,91 4,84 2,9 28 en% of total cal 3,91 3,01 3
PUFA (g/ 100ml) 1,50 (9 en %) 1,63 1,66 1,3 1,14 1,3
MCT (g/ 100ml) 1,2 (7 en %) none
EPA/ DHA from fishoil (g/ 100ml) 0,23 none none none 0,13
w6:w3 (3‐5:1) 2,4:1 2,6:1 2,6:1 2,9:1 2,4:1 1,96:1

CHO sources tapioca dextrin, maltodextrin, isomaltulose, modified maltodextrin corn maltodextrin, corn maltodextrin, fructose, corn starch tapioca starch, fructose pea puree,green bean
maltodextrin, isomaltulose, fructose (fibersol), fructose, isomaltulose, fructose, FOS isomaltulose, fructose, puree, peach puree, tapioca
fructose isomaltulose, glycerine, sucromalt, FOS dextrin, FOS
maltodextrin
Fructose (g/ 100ml) 1,5 3,2 3,2

BU 1,00
Fibre (g/ 100ml) 2,3 1,7 0,9 1,61 1,61 0,9 1,5 1,5
Fibre source tapioca fibre, cellulose, fructo-oligosaccharides, Soy and oat fibre, FOS, soy,oat soy hydrolysed guar hydrolysed guar FOS,Benefiber, soluble
inulin maltodextrin, oat fibre, soy fibersol fiber,soy fiber, vegetables,
fibre fruits
Fibre soluble/ insoluble 78%/22% 100% sol.

Osmolarity (mosmol/l) 450 614 614 572 389 389
Osmolality (mosmol/kg H2O) 800 875 720 480 450
560
Lactose (g/ 100ml) ≤0,048 ≤0,02 <0,1 <0,1
Chromium (mcg/100ml) 40 9 9 20 16 7 7,5 7,5 16
Vit C (mg/100ml) 12 13 13 32,5 26 12 4,6 4,6 24
Vit E (mg/100ml) 2,3 2,6 2,6 4,8 3,9 2,4 1 1 3,6[IU]
ß‐Carotene (mg/100ml) 0,2 0,0 0,0 3,3 2,7 none none
Flavonoids (mg/100ml) 0 none none none none none

Comparison
Diben 1.5 kcal HP vs. Glucerna 1.5
Advantages Advantages
Glucerna 1.5 Diben 1.5 kcal HP
Contains EPA and DHA from fish oil
Higher MUFA content

Contains MCT
Flavoured, can be used for sip and tube
feeding
Higher fibre content
Lower osmolarity
Available in 500 and 1000 ml EasyBag size
Contains higher amount of chromium

Comparison
Diben 1.5 kcal HP vs. Novasource Diabet Plus
Advantages Advantages
Novasourse Diabet Plus Diben 1.5 kcal HP
Flavoured, can be used for sip and tube Contains EPA and DHA from fish oil
feeding
Higher caloric density
Higher MUFA content
Lower SFA content
Higher fibre content
Higher content of Chromium
Contains ß-Carotine
Available in 500 and 1000 ml EasyBag size

Launch Support
Product logo Scientific Rational & Detailed Training
Packshots Fact Sheet, Sales Folder, Gimmick proposals
For better glycaemic https://apps.intra.fresenius.de/kabi/ensmile/SitePages/ENS

control mileLandingPage.aspx
Key Visual & Slogan Complete Launch Binder
Promotional support –
Fact sheet
 Product description
 Target patients
 Features & Benefits at a
glance
 Nutritional and prescribing
information
Sales Folder
 4-pager
 Product description
 Highlight & Details on key
features & benefits
 Nutritional and prescribing
information

Sales Folder – inside page

Sales Folder
 Focus on key feature

- modified CHO -
 Shows the benefits of
Isomaltulose
 Low GI of 22 (was
measured in vivo compared to
competitor which show slightly
higher GI)
High
GI
No relative Steady and longer engery

hypoglyceamia supply
Low GI
Decrease of
blood glucose
level below
initial value
Sales Folder
 Focus on key feature

- great fat profile &
- guidelines &
recommendations

Sales Folder
 Compiling the other

features and benefits

Gimmick proposals
Post-it in EasyBag format Aqua pen with swimming

fishes to underline the USP

Backup

Why a disease specific formula?
“diabetes-specific formulas are associated with improved glycemic control
compare with standard formulas”
Standard enteral
Rationale
formula
Low in CHO
High in CHO For better glycaemic control
high in fat  high in MUFA, & improved lipid metabolism
low in fat
with MTC & EPA +DHA
Isomaltulose, starch and

High in maltodextrins For a low GI
fructose
Normalisation of stool
Fibre to meet RDA for Balanced dietary fibre mix frequency and consistency to
healthy people with prebiotic inulin avoid diarrhoea or
constipation
Protein to meet RDA for High in protein with high To prevent exacerbation of
healthy people biological value protein catabolism
Antioxidant vitamins to meet Antioxidant vitamins to meet To help to reduce oxidative

RDA for healthy people RDA stress and protein glycation

Diben 1,5 kcal HP
Product features
High in energy (1.5 kcal/ml) Available in two sizes
High in protein (20 en% ) Nutritionally complete in 1500 kcal
High in DHA and EPA from fish oil Low in sodium
Modified carbohydrate profile Balanced fibre mix
High in MUFA Increased in Chromium
With MCT

Features and Benefits
 to provide concentrated nutrition in a
High in energy (1.5 kcal/ml) low volume
 to improve insulin sensitivity
High in protein  to support protein intake

(20 en% = 75 g/1.000 ml)  To prevent protein deficiency
Balanced fibre mixture including  to support a healthy gut function

prebiotic inulin  to ensure a good intestinal tolerance
 to counteract high postprandial

glucose
Modified carbohydrate profile
 to minimize blood glucose fluctations
 to ensure a low glycaemic index

Features and Benefits (2)
 to improve glycaemic control and

High in monounsaturated
dyslipidemia
fatty acids (MUFA)
 to improve insulin sensitivity
With medium chain triglycerides  to contribute to better lipid control

(MCT)  Easily absorbed source of energy
 to lower plasma triglycerides

Rich in EPA and DHA from fish oil  to protect against cardiovascular
disease
Cardio healthy fat composition:

- low in SFA  To reduce the risk of developing
- high in MUFA cardiovascular disease
- rich in fish oil  to reduce the risk of complications
- with a low n6 : n3 ratio of impaired glucose metabolism
- no trans-fatty acids

Features and Benefits (3)
Increased in Chromium  To support improving insulin

sensitivity
Low in sodium  to meet the needs of hypertensive

patients
 to provide all nutrients in a low

Nutritionally complete in volume
1000 ml = 1500 kcal  to be suitable for patients in need of
volume restriction
Available in two sizes:  to meet individual needs

500 ml and 1000 ml EasyBag

Diben 1,5 Kcal HP Detailed-Training Aug2014-Final

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Diben 1,5 Kcal HP Detailed-Training Aug2014-Final

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The newest member of the Diben family

Diben 1,5 kcal HP

© Copyright Fresenius Kabi Deutschland GmbH 1

Source: IDF Diabetes Atlas, 6th ed., 2013

MENA: Middle East and North Africa;

SEA: South-East Asia;

SACA: South and Central America;

WP: Western Pacific

NAC: North America and Caribbean;

Source: IDF Diabetes Atlas, 6th ed., 2013

Source: IDF Diabetes Atlas, 6th ed., 2013

Source: IDF Diabetes Atlas, 6th ed., 2013

Source: IDF Diabetes Atlas, 6th ed., 2013

Diabetes mellitus is a common disease among

~50% of type 2 diabetic patients are > 60 years

Prevalence of diabetes in hospitalized patients:

Prevalence of hyperglycaemia in hospitalized

Morley, J.E. Diabet Med, 1998. 15 Suppl 4: S41-6

 The number of people with type 2 diabetes is increasing in every country

 Almost 50% of type 2 diabetic patients are > 60 years of age

 Prevalence of diabetes in hospital settings: 15 - 30%

Prevalence hyperglyceamia in hospital settings up to 38%

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Net Sales: 168 mio € +15% growth vs PY*

Source: WMD 2012

© Copyright Fresenius Kabi Deutschland GmbH 11

Net Sales: 168 mio € +15% growth vs PY*

Source: WMD 2012,

Net Sales: 168 mio € +15% growth vs PY*

© Copyright Fresenius Kabi Deutschland GmbH 13

Net Sales: 84,5 mio € +14,8% growth vs PY*

Source: WMD 2012

© Copyright Fresenius Kabi Deutschland GmbH 14

Net Sales: 84 mio € +14,8% growth vs PY*

Source: WMD 2012

Net Sales: 47 mio € +3% growth vs PY

© Copyright Fresenius Kabi Deutschland GmbH 16

Forecast (according IOs) :

IOs are given from:

Additionally interested, evaluating launch:

* According IO, °According NPC

The ultimate goals for the

 Stabilize a positive lipid status

 to minimize blood glucose

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“diabetes-specific formulas are

Elia M. et al. Diabetes Care 2005 Sep;28(9):2267-79

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Improve glycaemic control

Reduce oxidative stress

Reduce diarrhoea and

Ley SH et al: Lancet (2014) 383(9933):1999-2007. Gonzalez-Campoy JM, et al: Endocrine

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Nutritionally complete, high-caloric,

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© Copyright Fresenius Kabi Deutschland GmbH 23

Excellent fat profile

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Nutrients Nutrient source

Carbohydrate Tapiocadextrin, maltodextrin, isomaltulose, fructose

Fibre Tapioca fibre, cellulose, inulin

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Average content: per 100 ml RDD = 1.000 ml