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Diabetologia
Published in: Diabetologia 6/2018

01-06-2018 | Review

Epidemiology of diabetes and diabetic complications in China

Author: Ronald C. W. Ma

Published in: Diabetologia | Issue 6/2018

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Abstract

The People’s Republic of China (herein referred to as China) has witnessed one of the most dramatic rises in diabetes prevalence anywhere in the world. The latest epidemiological study suggests that approximately 11% of the population has diabetes, with a significant proportion remaining undiagnosed. Risk factors for diabetes in the Chinese population are similar to those in other populations, though gestational diabetes and young-onset diabetes is becoming increasingly common. Data on the prevalence of diabetic complications remain limited, though cardio–renal complications account for significant morbidity and mortality. Other diabetes-related comorbidities are becoming increasingly common, with cancer emerging as a major cause of mortality among individuals with diabetes. There are many challenges and obstacles that impede effective diabetes prevention and the delivery of care, though much progress has occurred over recent years. Lessons learnt from how China has responded to the challenges posed by the diabetes epidemic will be invaluable for other countries facing the many threats of diabetes and its complications.
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Literature
1.
2.
Nanditha A, Ma RC, Ramachandran A et al (2016) Diabetes in Asia and the Pacific: implications for the global epidemic. Diabetes Care 39:472–485CrossRefPubMed
3.
Yang W, Lu J, Weng J et al (2010) Prevalence of diabetes among men and women in China. N Engl J Med 362:1090–1101CrossRefPubMed
4.
Xu Y, Wang L, He J et al (2013) Prevalence and control of diabetes in Chinese adults. JAMA 310:948–959CrossRefPubMed
5.
6.
National Diabetes Co-operative Study Group (1981) A mass survey of diabetes mellitus in a population of 300,000 in 24 provinces and municipalities in China. Zhonghua Nei Ke Za Zhi 20:678–683 [article in Chinese]
7.
Pan XR, Yang WY, Li GW, Liu J (1997) Prevalence of diabetes and its risk factors in China, 1994. National Diabetes Prevention and Control Cooperative Group. Diabetes Care 20:1664–1669CrossRefPubMed
8.
Wang K, Li T, Xiang H (1998) Study on the epidemiological characteristics of diabetes mellitus and IGT in China. Zhonghua Liu Xing Bing Xue Za Zhi 19:282–285 [article in Chinese]PubMed
9.
Gu D, Reynolds K, Duan X et al (2003) Prevalence of diabetes and impaired fasting glucose in the Chinese adult population: International Collaborative Study of Cardiovascular Disease in Asia (InterASIA). Diabetologia 46:1190–1198CrossRefPubMed
10.
11.
Gong C, Meng X, Jiang Y, Wang X, Cui H, Chen X (2015) Trends in childhood type 1 diabetes mellitus incidence in Beijing from 1995 to 2010: a retrospective multicenter study based on hospitalization data. Diabetes Technol Ther 17:159–165CrossRefPubMed
12.
Ma RC, Chan JC (2009) Diabetes: incidence of childhood type 1 diabetes: a worrying trend. Nat Rev Endocrinol 5:529–530CrossRefPubMed
13.
Jaacks LM, Liu W, Ji L, Mayer-Davis EJ (2015) Type 1 diabetes stigma in China: a call to end the devaluation of individuals living with a manageable chronic disease. Diabetes Res Clin Pract 107:306–307CrossRefPubMed
14.
McGuire HC, Ji L, Kissimova-Skarbek K et al (2017) Type 1 diabetes mellitus care and education in China: the 3C study of coverage, cost, and care in Beijing and Shantou. Diabetes Res Clin Pract 129:32–42CrossRefPubMed
15.
Ma RC, Lin X, Jia W (2014) Causes of type 2 diabetes in China. Lancet Diabetes Endocrinol 2:980–991CrossRefPubMed
16.
Du H, Li L, Bennett D et al (2017) Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: a 7-y prospective study of 0.5 million Chinese adults. PLoS Med 14:e1002279CrossRefPubMedPubMedCentral
17.
Zhang B, Zhai FY, Du SF, Popkin BM (2014) The China Health and Nutrition Survey, 1989-2011. Obes Rev 15(Suppl 1):2–7CrossRefPubMed
18.
Bi Y, Lu J, Wang W et al (2014) Cohort profile: risk evaluation of cancers in Chinese diabetic individuals: a longitudinal (REACTION) study. J Diabetes 6:147–157CrossRefPubMed
19.
Qin L, Corpeleijn E, Jiang C et al (2010) Physical activity, adiposity, and diabetes risk in middle-aged and older Chinese population: the Guangzhou biobank cohort study. Diabetes Care 33:2342–2348CrossRefPubMedPubMedCentral
20.
Ma RCW, Tsoi KY, Tam WH, Wong CKC (2017) Developmental origins of type 2 diabetes: a perspective from China. Eur J Clin Nutr 71:870–880CrossRefPubMed
21.
Li Y, He Y, Qi L et al (2010) Exposure to the Chinese famine in early life and the risk of hyperglycemia and type 2 diabetes in adulthood. Diabetes 59:2400–2406CrossRefPubMedPubMedCentral
22.
Ma RCW, Popkin BM (2017) Intergenerational diabetes and obesity—a cycle to break? PLoS Med 31(14):e1002415CrossRef
23.
Tam WH, Ma RCW, Ozaki R et al (2017) In utero exposure to maternal hyperglycemia increases childhood cardiometabolic risk in offspring. Diabetes Care 40:679–686CrossRefPubMedPubMedCentral
24.
Leng J, Shao P, Zhang C et al (2015) Prevalence of gestational diabetes mellitus and its risk factors in Chinese pregnant women: a prospective population-based study in Tianjin, China. PLoS One 10:e0121029CrossRefPubMedPubMedCentral
25.
Yeung RO, Zhang Y, Luk A et al (2014) Metabolic profiles and treatment gaps in young-onset type 2 diabetes in Asia (the JADE programme): a cross-sectional study of a prospective cohort. Lancet Diabetes Endocrinol 2:935–943CrossRefPubMed
26.
Chan JC, Lau ES, Luk AO et al (2014) Premature mortality and co-morbidities in young-onset diabetes—a 7 year prospective analysis. Am J Med 127:616–624CrossRefPubMed
27.
Luk AO, Lau ES, So WY et al (2014) Prospective study on the incidences of cardiovascular-renal complications in chinese patients with young-onset type 1 and type 2 diabetes. Diabetes Care 37:149–157CrossRefPubMed
28.
Huo X, Gao L, Guo L et al (2016) Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China: a cross-sectional study. Lancet Diabetes Endocrinol 4:115–124CrossRefPubMed
29.
Chan JC, Zhang Y, Ning G (2014) Diabetes in China: a societal solution for a personal challenge. Lancet Diabetes Endocrinol 2:969–979CrossRefPubMed
30.
Ma RC, Chan JC (2013) Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States. Ann N Y Acad Sci 1281:64–91CrossRefPubMedPubMedCentral
31.
Jia WP, Pang C, Chen L et al (2007) Epidemiological characteristics of diabetes mellitus and impaired glucose regulation in a Chinese adult population: the Shanghai Diabetes Studies, a cross-sectional 3-year follow-up study in Shanghai urban communities. Diabetologia 50:286–292CrossRefPubMed
32.
33.
Bennett PH, Lee ET, Lu M, Keen H, Fuller JH (2001) Increased urinary albumin excretion and its associations in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia 44(Suppl 2):S37–S45CrossRefPubMed
34.
Chi ZS, Lee ET, Lu M, Keen H, Bennett PH (2001) Vascular disease prevalence in diabetic patients in China: standardised comparison with the 14 centres in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia 44(Suppl 2):S82–S86CrossRefPubMed
35.
Lee ET, Keen H, Bennett PH, Fuller JH, Lu M (2001) Follow-up of the WHO Multinational Study of Vascular Disease in Diabetes: general description and morbidity. Diabetologia 44(Suppl 2):S3–S13CrossRefPubMed
36.
Clarke PM, Glasziou P, Patel A et al (2010) Event rates, hospital utilization, and costs associated with major complications of diabetes: a multicountry comparative analysis. PLoS Med 7:e1000236CrossRefPubMedPubMedCentral
37.
Chan JC, So W, Ma RC, Tong PC, Wong R, Yang X (2011) The complexity of vascular and non-vascular complications of diabetes: the Hong Kong Diabetes Registry. Curr Cardiovasc Risk Rep 5:230–239CrossRefPubMedPubMedCentral
38.
Luk AO, Ma RC, Lau ES et al (2013) Risk association of HbA1c variability with chronic kidney disease and cardiovascular disease in type 2 diabetes: prospective analysis of the Hong Kong Diabetes Registry. Diabetes Metab Res Rev 29:384–390CrossRefPubMed
39.
Luk AOY, Hui EMT, Sin MC et al (2017) Declining trends of cardiovascular-renal complications and mortality in type 2 diabetes: the Hong Kong Diabetes Database. Diabetes Care 40:928–935CrossRefPubMed
40.
Ozaki R, Jiang G, Xie F et al (2016) High prevalence of cardio-renal complications among Chinese subjects with type 2 diabetes–the Hong Kong Diabetes Biobank. Diab Res Clin Pract 120:S46–S47CrossRef
41.
Ji L, Hu D, Pan C et al (2013) Primacy of the 3B approach to control risk factors for cardiovascular disease in type 2 diabetes patients. Am J Med 126(925):e911–e922
42.
Li L, Ji L, Guo X et al (2015) Prevalence of microvascular diseases among tertiary care Chinese with early versus late onset of type 2 diabetes. J Diabetes Complicat 29:32–37CrossRefPubMed
43.
Liu Z, Fu C, Wang W, Xu B (2010) Prevalence of chronic complications of type 2 diabetes mellitus in outpatients—a cross-sectional hospital based survey in urban China. Health Qual Life Outcomes 8:62CrossRefPubMedPubMedCentral
44.
Jia W, Gao X, Pang C et al (2009) Prevalence and risk factors of albuminuria and chronic kidney disease in Chinese population with type 2 diabetes and impaired glucose regulation: Shanghai diabetic complications study (SHDCS). Nephrol Dial Transplant 24:3724–3731CrossRefPubMed
45.
Lu B, Wen J, Song XY et al (2007) High prevalence of albuminuria in population-based patients diagnosed with type 2 diabetes in the Shanghai downtown. Diabetes Res Clin Pract 75:184–192CrossRefPubMed
46.
Zhou Y, Echouffo-Tcheugui JB, Gu JJ et al (2013) Prevalence of chronic kidney disease across levels of glycemia among adults in Pudong New Area, Shanghai, China. BMC Nephrol 14:253CrossRefPubMedPubMedCentral
47.
Yang X, So W, Ko GT et al (2008) Independent associations between low-density lipoprotein cholesterol and cancer among patients with type 2 diabetes mellitus. CMAJ 179:427–437CrossRefPubMedPubMedCentral
48.
Seshasai SR, Kaptoge S, Thompson A et al (2011) Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med 364:829–841CrossRef
49.
Bragg F, Holmes MV, Iona A et al (2017) Association between diabetes and cause-specific mortality in rural and urban areas of China. JAMA 317:280–289CrossRefPubMed
50.
Ning G, Bloomgarden Z (2015) Diabetes and cancer: findings from the REACTION studyREACTION. J Diabetes 7:143–144CrossRefPubMed
51.
So WY, Yang X, Ma RC et al (2008) Risk factors in V-shaped risk associations with all-cause mortality in type 2 diabetes-the Hong Kong Diabetes Registry. Diabetes Metab Res Rev 24:238–246CrossRefPubMed
52.
Zhang Y, Ting RZ, Yang W et al (2015) Depression in Chinese patients with type 2 diabetes: associations with hyperglycemia, hypoglycemia, and poor treatment adherence. J Diabetes 7:800–808CrossRefPubMedPubMedCentral
53.
Xu W, Caracciolo B, Wang HX et al (2010) Accelerated progression from mild cognitive impairment to dementia in people with diabetes. Diabetes 59:2928–2935CrossRefPubMedPubMedCentral
54.
Ma F, Wu T, Miao R, Xiao YY, Zhang W, Huang G (2015) Conversion of mild cognitive impairment to dementia among subjects with diabetes: a population-based study of incidence and risk factors with five years of follow-up. J Alzheimers Dis 43:1441–1449PubMed
55.
Zhou M, Astell-Burt T, Bi Y et al (2015) Geographical variation in diabetes prevalence and detection in china: multilevel spatial analysis of 98,058 adults. Diabetes Care 38:72–81CrossRefPubMed
56.
Pan XR, Li GW, Hu YH et al (1997) Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study Diabetes care 20:537–544
57.
Li G, Zhang P, Wang J et al (2014) Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study. Lancet Diabetes Endocrinol 2:474–480CrossRefPubMed
58.
Tian Y, Jiang C, Wang M et al (2016) BMI, leisure-time physical activity, and physical fitness in adults in China: results from a series of national surveys, 2000-14. Lancet Diabetes Endocrinol 4:487–497CrossRefPubMed
59.
Zhou X, Qiao Q, Ji L et al (2013) Nonlaboratory-based risk assessment algorithm for undiagnosed type 2 diabetes developed on a nation-wide diabetes survey. Diabetes Care 36:3944–3952CrossRefPubMedPubMedCentral
60.
Song C, Li J, Leng J, Ma RC, Yang X (2016) Lifestyle intervention can reduce the risk of gestational diabetes: a meta-analysis of randomized controlled trials. Obes Rev 17:960–969CrossRefPubMed
61.
Ko GT, Chan JC, Tsang LW, Li CY, Cockram CS (1999) Glucose intolerance and other cardiovascular risk factors in Chinese women with a history of gestational diabetes mellitus. Aust N Z J Obstet Gynaecol 39:478–483CrossRefPubMed
62.
Hanson MA, Gluckman PD, Ma RC, Matzen P, Biesma RG (2012) Early life opportunities for prevention of diabetes in low and middle income countries. BMC Public Health 12:1025CrossRefPubMedPubMedCentral
63.
Yan J, Yang H (2014) Gestational diabetes in China: challenges and coping strategies. Lancet Diabetes Endocrinol 2:930–931CrossRefPubMed
64.
Yang W, Liu J, Shan Z et al (2014) Acarbose compared with metformin as initial therapy in patients with newly diagnosed type 2 diabetes: an open-label, non-inferiority randomised trial. Lancet Diabetes Endocrinol 2:46–55CrossRefPubMed
65.
Kim YG, Hahn S, Oh TJ, Kwak SH, Park KS, Cho YM (2013) Differences in the glucose-lowering efficacy of dipeptidyl peptidase-4 inhibitors between Asians and non-Asians: a systematic review and meta-analysis. Diabetologia 56:696–708CrossRefPubMed
66.
Weng J, Li Y, Xu W et al (2008) Effect of intensive insulin therapy on β-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial. Lancet 371:1753–1760CrossRefPubMed
67.
Ma RC, Jiang G, Tam CHT et al (2017) Clinical and genetic determinants of progression in type 2 diabetes. Diabetes 66:A456 (abstract)
68.
Wang W, McGreevey WP, Fu C et al (2009) Type 2 diabetes mellitus in China: a preventable economic burden. Am J Manag Care 15:593–601PubMed
69.
70.
Luk AO, Li X, Zhang Y et al (2016) Quality of care in patients with diabetic kidney disease in Asia: the Joint Asia Diabetes Evaluation (JADE) Registry. Diabet Med 33:1230–1239CrossRefPubMed
71.
Jia W (2014) Diabetes: a challenge for China in the 21st century. Lancet Diabetes Endocrinol 2:e6–e7CrossRefPubMed
72.
Fisher EB, Brownson CA, O’Toole ML, Shetty G, Anwuri VV, Glasgow RE (2005) Ecological approaches to self-management: the case of diabetes. Am J Public Health 95:1523–1535CrossRefPubMedPubMedCentral
73.
Guo XH, Yuan L, Lou QQ et al (2012) A nationwide survey of diabetes education, self-management and glycemic control in patients with type 2 diabetes in China. Chin Med J 125:4175–4180PubMed
74.
Chan JC, Sui Y, Oldenburg B et al (2014) Effects of telephone-based peer support in patients with type 2 diabetes mellitus receiving integrated care: a randomized clinical trial. JAMA Intern Med 174:972–981CrossRefPubMed
75.
Tutino GE, Yang WY, Li X et al (2017) A multicentre demonstration project to evaluate the effectiveness and acceptability of the web-based Joint Asia Diabetes Evaluation (JADE) programme with or without nurse support in Chinese patients with type 2 diabetes. Diabet Med 34:440–450CrossRefPubMed
76.
Metadata
Title
Epidemiology of diabetes and diabetic complications in China
Author
Ronald C. W. Ma
Publication date
01-06-2018
Publisher
Springer Berlin Heidelberg
Published in
Diabetologia / Issue 6/2018
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-018-4557-7

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