China Faces Massive Wave of Diabetes-Linked Chronic Diseases

Janis C. Kelly

September 03, 2013

China is facing an epidemic of diabetes and of diseases for which diabetes is a major risk factor, including ischemic heart disease, stroke, and chronic kidney disease, according to a massive study of nearly 100,000 Chinese adults reported in the September 4 issue of the Journal of the American Medical Association.

Among the key points reported by Yu Xu, PhD, from the Shanghai Jiao-Tong University School of Medicine, China, and colleagues for the 2010 China Noncommunicable Disease Surveillance Group:

  • Diabetes prevalence was 11.6% (12.1% in men, 11.0% in women).

  • Two-thirds of diabetes cases were undiagnosed.

  • Only 25.8% of diabetics were receiving treatment.

  • Among those treated, fewer than 40% had adequate glycemic control.

  • Over half of Chinese adults were prediabetic (no prior diagnosis, but fasting plasma glucose 100 to 125 mg/dL, 2-hour plasma glucose 140 to 199 mg/dL, or HbA1c 5.7% to 6.4%).

"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 authors write.

Dramatic Increase in Diabetes Prevalence in Past Decade

The current study documents a dramatic increase in diabetes prevalence, which was less than 1% in the Chinese population in 1980 and only 5.5% as recently as 2000–2001, according to the researchers.

"Projections based on sample weighting suggest this may represent up to 113.9 million [diabetic] and 493.4 million [prediabetic] adults, respectively," they say.

These conclusions are based on work by Dr. Xu and colleagues using a multistage, probability sampling design to conduct a cross-sectional survey in a nationally representative sample of 98,658 Chinese adults. The researchers measured plasma glucose and hemoglobin A1c levels after at least a 10-hour overnight fast among all study participants and conducted 2-hour oral glucose-tolerance tests among participants without a self-reported history of diagnosed diabetes. Diabetes and prediabetes were defined according to the 2010 American Diabetes Association criteria; a hemoglobin A1c level of <7.0% was considered adequate glycemic control.

The researchers note that they did not distinguish between type 1 and type 2 diabetes in the study but that "type 2 diabetes is the predominant form of diabetes in adults."

Diabetes prevalence was higher in urban residents, in men over 50 years and women over 60 years, in the overweight or obese, and in more economically developed areas of China. Prediabetes prevalence was higher in rural residents and in economically underdeveloped regions.

Several unusual associations were uncovered in multivariable analysis, which showed that current cigarette smoking, alcohol consumption, higher serum HDL-cholesterol level, and living in intermediately developed regions were associated with lower risk for diabetes, while higher education, higher serum HDL-cholesterol and triglycerides levels, and living in intermediately developed and developed regions were associated with lower risk for prediabetes.

Diabetes Alert: Preventive Action Must Be Taken in China

"Diabetes is a societal and a healthcare 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," observes Juliana C.N. Chan, MD, from the Chinese University of Hong Kong Prince of Wales Hospital International Diabetes Federation Centre of Education, Shatin, in an accompanying editorial.

"Inadequate control of fasting plasma glucose and HbA1c in China herald a looming and massive epidemic of chronic diseases, if prompt preventive actions are not taken," Dr. Chan warns.

The study was supported by the Chinese Ministry of Finance; the Key Laboratory for Endocrine and Metabolic Diseases of the Ministry of Health; the Sector Funds of the Ministry of Health; the National Key New Drug Creation and Manufacturing Program of  the Ministry of Science and Technology; the National High Technology Research and Development Program of China; and the National Natural Science Foundation of China. The authors reported no relevant financial relationships. Dr. Chan reported no relevant financial relationships.

JAMA. 2013;310:948-958,916-917.

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