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Prevalence and Treatment of Diabetes in China, 2013-2018

Educational Objective
To learn the changes in diabetes and prediabetes prevalence in China from 2013 to 2018.
1 Credit CME
Key Points

Question  What is the prevalence of diabetes and prediabetes and diabetes treatment in China?

Findings  In this nationally representative cross-sectional study conducted in mainland China with 173 642 participants in 2018, the estimated overall prevalence of diabetes was 12.4% and of prediabetes was 38.1%, with awareness of diabetes in 36.7%, treatment in 32.9%, and adequate control in 50.1%. Among the 170 287 participants enrolled in 2013, the estimated prevalence of diabetes was 10.9% and of prediabetes was 35.7%.

Meaning  Estimated diabetes prevalence in China increased significantly from 2013 to 2018, with a low estimated prevalence of adequate treatment.

Abstract

Importance  Recent data on prevalence, awareness, treatment, and risk factors of diabetes in China is necessary for interventional efforts.

Objective  To estimate trends in prevalence, awareness, treatment, and risk factors of diabetes in China based on national data.

Design, Setting, and Participants  Cross-sectional nationally representative survey data collected in adults aged 18 years or older in mainland China from 170 287 participants in the 2013-2014 years and 173 642 participants in the 2018-2019 years.

Exposures  Fasting plasma glucose and hemoglobin A1c levels were measured for all participants. A 2-hour oral glucose tolerance test was conducted for all participants without diagnosed diabetes.

Main Outcomes and Measures  Primary outcomes were diabetes and prediabetes defined according to American Diabetes Association criteria. Secondary outcomes were awareness, treatment, and control of diabetes and prevalence of risk factors. A hemoglobin A1c level of less than 7.0% (53 mmol/mol) among treated patients with diabetes was considered adequate glycemic control.

Results  In 2013, the median age was 55.8 years (IQR, 46.4-65.2 years) and the weighted proportion of women was 50.0%; in 2018, the median age was 51.3 years (IQR, 42.1-61.6 years), and the weighted proportion of women was 49.5%. The 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). 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). 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; 50.1% (95% CI, 47.5%-52.6%) of patients receiving treatment were controlled adequately. These rates did not change significantly from 2013. From 2013 to 2018, low physical activity, high intake of red meat, overweight, and obesity significantly increased in prevalence.

Conclusions and Relevance  In this survey study, the estimated diabetes prevalence was high and increased from 2013 to 2018. There was no significant improvement in the estimated prevalence of adequate treatment.

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Article Information

Corresponding Authors: Jing Wu, PhD, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Rd, Xicheng District, 100050 Beijing, China (wujing@chinacdc.cn); Youfa Wang, MD, PhD, Global Health Institute, Xi’an Jiaotong University Health Science Center, Room 3104, No. 21 Hongren Building, West China Science and Technology Innovation Harbour (iHarbour), 710061 Xi’an, Shaanxi, China (youfawang@gmail.com).

Accepted for Publication: November 23, 2021.

Correction: This article was corrected on March 15, 2022, to fix the symbol in the overweight and obesity row of Table 5 and to show the ranges of the overweight and obesity rows as subcategories.

Author Contributions: Drs Limin Wang and Y. Wang had full access to all of the data in the study and take responsibility for the integrity of the study and the accuracy of the data analysis. Drs Limin, Wang, Peng, and Zhao contributed equally.

Concept and design: Y. Wang, Limin Wang, Wu, Peng.

Acquisition of data or filed quality control: Limin Wang, Zhao, M. Zhang, X. Zhang, C. Li, Huang, Linhong Wang, Zhou, Wu.

Drafting of the manuscript: Peng, Limin Wang, Zhao, Y. Wang.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Zhao, M. Zhang, Song, Shi, Peng, Limin Wang, Y. Wang.

Interpretation of data: All authors

Administrative, technical, or material support: Y. Wang, Limin Wang, Wu.

Supervision: Y. Wang, Limin Wang, Wu.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported in part by research grants 2018YFC1311706, 2017YFC0907200, and 2017YFC0907201 from the National Key Research and Development Program of China, the Chinese central government (key project of public health program 2013 and 2018), and grant 821603846 from the National Scientific Foundation of China.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank the Chinese Center for Disease Control and Prevention staff and those in the 31 provincial level administrative areas in China and the local investigators in the 298 Disease Surveillance Sites for their efforts in data collection. We also thank Ke Li, BA, from Xi’an Jiaotong University for her assistance in editing the manuscript. She did not receive compensation for her role in the study.

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