The Diabetes Epidemic in China: An Integrated Review of National Surveys

Xiuhua Shen, MD, PhD; Anand Vaidya, MD; Shoulin Wu, MD; Xiang Gao, MD, PhD


Endocr Pract. 2016;22(9):1119-1129. 

In This Article

Abstract and Introduction


Objective: To review trends in the prevalence and incidence of diabetes mellitus (DM) and related risk factors in China.

Methods: We searched the literature using PubMed, China Knowledge Resource Integrated Database, and China Wanfang Digital Database for large epidemiologic studies and national surveys.

Results: During the past 30 years (1980–2010), 7 national diabetes mellitus surveys were conducted in China mainland, indicating that the prevalence of DM has increased 17-fold, from 0.67 to 11.6% of the population. The prevalence of impaired glucose regulation (IGR, including impaired fasting glucose and impaired glucose tolerance) also increased, from 2.09 in 1994 to 27.2% in 2010. There was no national representative study of the incidence of diabetes to date; the reported incidence of type 2 diabetes during past 25 years in several cohort studies varied (2.7 to 15.8 per 1,000 person-years). Potential risk factors which could have contributed to the increasing prevalence and incidence of DM and IGR in the Chinese population include social and economic development, urbanization, dietary pattern, and Westernized lifestyle. Further, genetic studies have suggested that unique inheritable risk factors in the Chinese population may increase the risk for DM when compared to Caucasians.

Conclusion: DM and IGR have become epidemic in China. Public health strategies should focus on modifying lifestyle and dietary factors, particularly among those with a susceptible genetic background.


Type 2 diabetes mellitus (DM) has rapidly become one of the most common noncommunicable diseases globally and is one of the most challenging public health issues.[1] The International Diabetes Federation has estimated that 382 million people had diabetes worldwide in 2013, and by 2035, this will rise to 592 million.[1] Approximately 80% of people with diabetes live in low- and middle-income countries.[1] In China, a rapid increase in the prevalence of DM has been reported.[2] Comparing the latest national DM survey in 2010 to the first one in 1981,[3] the prevalence of DM has increased 17-fold.[2,3] This is relevant, since diabetes increases the risk of developing microvascular and macrovascular complications as well as premature death, leading to a large economic burden on society and government.

A thorough understanding of the prevalence of diabetes and its modifiable risk factors is important in designing rational prevention programs to reduce the burden of disease. Here, we review the epidemiologic trends, in both prevalence and incidence of DM, and the major modifiable risk factors that may have led to the rapid rise in DM in mainland China, based on national surveys conducted during the past decades.