Diabetes in China: The challenge now

China has made astonishing strides in economic development and has emerged as a strong global partner during the past 30 years. However, the rapid improvement of the standard of living has also exposed the Chinese to new risks that was once thought to be the preserve of the west. New estimates from a population-based national study carried out in 2008–2009 reported 92.4 million people with diabetes and 148.2 million people with pre-diabetes. China, ahead of India now, has become the country with the largest number of people with diabetes in the world (Figure 1). When looking back over the past 15 years, we can see a leap in the prevalence of diabetes in China, in which it increased markedly from 2.0% in 1995 to 5.5% in 2001 and to 9.7% in 2009. The rate of increase is much faster than the USA, India, Japan and the UK (Figure 2). It is, actually, not entirely surprising. The rate of chronic ailments, such as high blood pressure and heart disease – the health problems linked to growing prosperity, has also been steadily climbing in China. Diabetes is a major risk for stroke, heart attack and kidney disease, and the costs incurred by diabetes mobility are far greater than the costs of preventing the disease. It stands that China faces a heavy health care burden and expenditure attributable to diabetes. The estimated national direct medical costs for diabetes and its complications, based on the estimated case numbers of 23.46 million, are reported to be $26 billion a year or 18.2% of China’s total health expenditure in 2007. The latest figures will mean health care expenditure on diabetes in 2010 will increase dramatically. Given the disproportionately high ratio of pre-diabetes to diabetes, health expenditure will increase substantially in coming decades. Like many other developing counties, China has experienced dramatic socioeconomic and cultural transitions. The aging of the population, nutritional changes and increasingly sedentary lifestyles, with a consequent epidemic of obesity, have contributed to the national diabetes epidemic. It has something to do with urbanization, but it is also part of a cultural shift away from traditional lifestyles, centered on food rich in fiber and physical activity, to Western modern lifestyles, centered on fatty food and lack of exercise. These have had a particularly large impact in China, but these are modifiable factors. That eating a healthy diet and becoming physically more active can prevent diabetes has been convincingly proven by China’s Daqing Impaired Glucose Tolerance and Diabetes Study. These findings underline that developing education models calling for the general public to adopt healthy lifestyles is significant for reducing the diabetes epidemic in the future. However, this is a big challenge, because the fastfood cultural model is now as deeply rooted in Chinese daily life as in Europe and the USA. We are caring for a huge population with diagnosed diabetes; we are also concerned about the number of people with undiagnosed diabetes. Studies have shown that there is a period of asymptomatic or latent diabetes before clinical recognition; many patients at the time of diagnosis already have diabetic complications. New figures reported that 60.7% of people with diabetes are undiagnosed, among which nearly half of the undiagnosed diabetes met the criteria of elevated 2-h plasma glucose levels, but not the criteria for fasting glucose levels. A previous study also found that nearly half of inpatients with hyperglycemia had undiagnosed diabetes before admission to a tertiary hospital of Guangdong Province. It is likely to result from public unawareness, but it is also likely to be a result of limited medical resources. Incomplete coverage, uneven Corresponding author. Jianping Weng Tel.: +86-20-85252107 Fax: +86-20-85252107 E-mail address: [email protected] Received 2 June 2010; revised 10 June 2010; accepted 11 June 2010 0 250 500 75