Study: Nearly 12% of Chinese adults have diabetes and about 50% at risk of developing the disease

The JAMA Network JournalsSep 4 2013

A study based on a nationally representative sample of adults in China in 2010 indicates that nearly 12 percent of Chinese adults had diabetes and the prevalence of prediabetes was about 50 percent, according to a study in the September 4 issue of JAMA.

"Noncommunicable chronic diseases have become the leading causes of mortality and disease burden worldwide. It was estimated that 34.5 million deaths globally were due to noncommunicable diseases in 2010, which reflected a significant increase from 1990. Mortality from diabetes doubled during this period and increased to 1.3 million deaths worldwide in 2010. In addition, diabetes is a major risk factor for ischemic heart disease and stroke, which collectively killed an estimated 12.9 million people globally in 2010," according to background information in the article.

"The prevalence of diabetes has increased significantly in recent decades and is now reaching epidemic proportions in China. The prevalence of diabetes was less than 1 percent in the Chinese population in 1980. In subsequent national surveys conducted in 1994 and 2000-2001, the prevalence of diabetes was 2.5 percent and 5.5 percent, respectively. The most recent national survey in 2007 reported that the prevalence of diabetes was 9.7 percent, representing an estimated 92.4 million adults in China with diabetes."

Yu Xu, Ph.D., of the Shanghai Jiao-Tong University School of Medicine, Shanghai, China, and colleagues with the 2010 China Noncommunicable Disease Surveillance Group, conducted a study to investigate the prevalence of diabetes and glycemic control in the Chinese adult population. Using a multistage, probability sampling design, the researchers conducted a cross-sectional survey in a nationally representative sample of 98,658 Chinese adults in 2010. Plasma glucose and hemoglobin A1c levels were measured after at least a 10-hour overnight fast among all study participants, and a 2-hour oral glucose tolerance test was conducted among participants without a self-reported history of diagnosed diabetes. Diabetes and prediabetes were defined according to the 2010 American Diabetes Association criteria; whereas, a hemoglobin A1c level of <7.0 percent was considered adequate glycemic control.

The researchers found that the overall prevalence of diabetes was estimated to be 11.6 percent in the Chinese adult population; 12.1 percent in men, and 11.0 percent in women, with an estimated prevalence of 8.1 percent for newly detected diabetes. "The prevalence of diabetes was higher in urban than in rural residents in both men and women. Furthermore, diabetes prevalence increased with age in both men and women, and men younger than 50 years had a higher prevalence, whereas women older than 60 years had a higher prevalence. In addition, the prevalence of diabetes increased with economic development, as well as in overweight and obese persons."

The estimated prevalence of prediabetes was 50.1 percent in Chinese adults: 52.1 percent in men and 48.1 percent in women. Rural residents had slightly higher prevalence of prediabetes than did urban residents, especially in men. Additionally, prediabetes was more prevalent in economically underdeveloped regions, as well as in overweight and obese persons.

The authors also found that the proportion of patients with diabetes who were aware of their condition was 30.1 percent among the Chinese general population. Only 25.8 percent of overall patients with diabetes were treated for this condition, and only 39.7 percent of those treated had adequate glycemic control.

"These data suggest that diabetes may have reached an alert level in the Chinese general population, with the potential for a major epidemic of diabetes-related complications, including cardiovascular disease, stroke, and chronic kidney disease in China in the near future without an effective national intervention," the researchers write. "These findings indicate the importance of diabetes as a public health problem in China."

"Diabetes is a societal and a health care challenge due to complex interplays among genetic, perinatal, lifestyle, and environmental factors, to name but a few. Rapid modernization has resulted in an obesogenic environment characterized by food abundance, physical inactivity, and psychosocial stress," writes Juliana C. N. Chan, M.D., F.R.C.P., of the Chinese University of Hong Kong Prince of Wales Hospital International Diabetes Federation Centre of Education, Shatin, Hong Kong, in an accompanying editorial.

"The lack of awareness, information, and feedback has caused many individuals unknowingly to engage in risk-conferring behaviors. Even when the individual becomes aware of his or her risk conditions, the health care systems in many developing areas are not designed to manage and support a person's multiple health needs for 30 to 40 years or more. These needs include motivation, cognitive-psychological-behavioral support, laboratory assessments, technologies, medications, and hospitalizations."

"In the final analysis, the WHO defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. To this end, government leaderships, partnerships, and community empowerment will be needed to create a health-promoting environment, encourage self-management, and strengthen the health care system to make health a reality."