Low achievement of guideline-recommended diabetes targets in Chinese adults

1. In this cross-sectional study, the proportion of Chinese adults with self-reported type 2 diabetes who achieved a guideline-recommended HbA1c target was 64.1%. 

2. The proportion of Chinse adults with self-reported type 2 diabetes who achieved a guideline-recommended blood pressure was 22.2%.

Evidence Rating Level: 1 (Excellent)

Study Rundown: More than one-quarter of the Chinese population has been diagnosed with diabetes, and estimates project that direct health expenditures for diabetes in China will continue to grow above $109 billion. Thus, it is crucial to maintain guideline-recommended targets in diabetes management to reduce complications, improve the quality of life, and reduce costs. However, there is a gap in knowledge as to understanding whether nationwide achievement of and compliance with dietary, lifestyle, body mass index (BMI), and major clinical risk factor control targets is satisfactory in this population. Overall, this study found that Chinese adults with self-reported diabetes had suboptimal achievement of all guideline-recommended diabetes care targets, especially with regard to low-density lipoprotein-cholesterol (LDL-C) levels, blood pressure, leisure time activity, and dietary targets. This study was limited by using self-reported data and using relatively outdated data. Nevertheless, these study’s findings are significant, as they suggest that achievement of guideline-recommended diabetes care targets is low across China and thus national health actions are needed to improve diabetes management.

Click to read the study in AIM

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In-Depth [cross-sectional study]: This nationwide cross-sectional study took a national sample of 8401 adults with self-reported diabetes across all of mainland China. Patients who were aged 18 years or older and not pregnant were eligible for the study. Patients who did not respond to the 2015-2017 nationwide survey or did not have self-reported diabetes were excluded from the study. The primary outcome measured was HbA1c level, LDL-C levels, blood pressure, BMI, and lifestyle variables such as smoking status, physical activity, and sleep duration. Outcomes in the primary analysis were assessed via logistic regressions with age and sex-adjusted proportions as well as multivariable logistic regressions. Based on the primary analysis, 64.1% (95% Confidence Interval [CI], 61.4% to 66.8%) of adults reported that they had achieved their target for hemoglobin A1C, 22.2% reported hitting the target for blood pressure (95% CI, 20.2% to 24.1%), and 23.9% (CI, 21.9% to 25.9%) reported achieving the target for LDL-C levels. In total, 32.2% (95% CI, 30.3% to 34.2%) reported achieving a BMI below 24 kg/m^2, and the proportion of patients achieving each lifestyle target was 75.8% (95% CI, 73.9% to 77.7%) for smoking, 66.7% (95% CI, 64.4% to 69.1%) for drinking, 17.9% (95% CI, 15.8% to 20.1%) for leisure time activity, and 52.0% (9% CI, 49.6% to 54.3%) for sleep duration. In summary, this study demonstrates that achievement of guideline-recommended diabetes care targets for Chinese adults with self-reported diabetes is very low across China.

Image: PD

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