Significant Increase in Diabetes Prevalence Observed in China

In comparison to the United States, previous research has relayed low rates of awareness, treatment, and control of diabetes in China.

A recent study thus set out to describe time trends in the prevalence of diabetes and prediabetes, awareness and treatment of diabetes, and risk factors associated with diabetes using representative data collected in 2013 - 2014 and 2018 - 2019 survey cycles in China.

Led by Jing Wu, PhD, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, investigators found the estimated diabetes prevalence was high with an increase during the study cycles from 2013 to 2018, with no significant improvement in the estimated prevalence of adequate treatment.

Methods

Data was collected from the ongoing, cross-sectional China Chronic Disease and Risk Factors Surveillance study to monitor prevalence of major noncommunicable diseases and risk factors in the country. The latest surveys occurred in the cycles of June 2013 - May 2014 and August 2018 - June 2019.

Participants aged 18 years or older were included, with 170,287 participants from 2013 - 2014 and 173,642 participants in 2018 - 2019 in the study.

Each survey included questionnaire interviews, anthropometric measurements, and blood sample collection and measurements. All participants were measured for plasma glucose following an overnight fast and at 2 hours after a 75-g oral glucose tolerance test for participants without self-reported diabetes history. Additionally, hemoglobin A1c (HbA1c) was measured using venous blood samples within 4 weeks of blood collection.

Self-reported risk factors included ethnicity, education, smoking status, excessive alcohol consumption, low physical activity, low fruit and vegetable intake, and high red meat intake.

Primary outcomes were considered the prevalence of diabetes and prediabetes according to American Diabetes Association criteria, while secondary outcomes included awareness, treatment, and control of diabetes and prevalence of risk factors. Further, the control rate was defined as the proportion of individuals with an HbA1c level of ≤7.0% in patients receiving treatment for diabetes.

Findings

Data show a median age of 55.8 years in 2013, with the weighted proportion of women at 50.0%. In 2018, the median age was 51.3 years and the weighted proportion of women was 49.5%. Based on Chinese BZMI standards, 34.5% were overweight and 16.5% had obesity.

The overall standardized estimated prevalence of diabetes increased from 10.9% (95% CI, 10.4% - 11.5%) in 2013 to 12.4% (95% CI, 11.8% - 13.0%) in 2018 (P <.001). Then, the estimated prevalence of prediabetes was 35.7% (95% CI, 34.2% - 37.3%) in 2013 and 38.1% (95% CI, 36.4% - 39.7%) in 2018 (P = .07).

Wu and colleagues noted the combined prevalence of diabetes and prediabetes in 2018 was 50.5%. Data show women had a significantly lower prevalence of diabetes and prediabetes than men in both 2013 (10.2%, 95% CI, 9.7% - 10.7% versus men 11.7%, 95%, 11.0% - 12.4%) and 2018 (11.5%, 95% CI, 10.8% - 12.2% versus 13.3%, 95% CI, 12.6% - 14.0%).

Further, in 2018, among adults with diabetes, 36.7% (95% CI, 34.7% - 38.6%) reported being aware of their condition and 32.9% (95% CI, 30.9% - 34.8%) reported being treated with medication, dietary control, or increased activity. From this population, 50.1% (95% CI, 47.5% - 52.6%) of patients receiving treatment were controlled adequately. There were no significant changes from 2013 to 2018.

Additionally, from 2013 - 2018, significant increases in prevalence of low physical activity (16.0% to 22.0%), high intake of red meat (32.6% to 42.3%), overweight (32.5% to 34.5%), and obesity (14.1% to 16.5%) were observed.

Takeaways

Wu and colleagues noted that these findings may have important public health implications, with comprehensive actions needed to address the growing national diabetes burden.

“To address the increasing diabetes burden in China, translation and implementation studies are required to develop better integrated, tailored, and sustainable interventions,” investigators wrote.

The study, “Prevalence and Treatment of Diabetes in China, 2013-2018,” was published in JAMA.