Prevalence of diabetes mellitus in China, 2013-2018

1. In this cross-sectional study, the prevalence of diabetes was estimated to rise from 10.9% in 2013 to 12.4% in 2018 amongst a representative sample of Chinese adults.

Evidence Rating Level: 3 (Average)

Study Rundown: Chronic, noncommunicable diseases are becoming increasingly important drivers of morbidity and mortality around the world. Important examples of these diseases include obesity, diabetes and dyslipidemia. The present study sought to estimate the prevalence of diabetes amongst Chinese adults between 2013 and 2018. Study data for a representative sample of Chinese adults were obtained from an ongoing, national study database. The response rate in 2013 was 93.4% (170,287 individuals) and in 2018 was 96.8% (173,642 individuals). Data of interest included both questionnaires and biological samples. In 2018, 50.1% of men were current smokers, 44.4% of adults reported low fruit and vegetable intake and 51% were overweight or obese. The overall prevalence of diabetes increased from 10.9% in 2013 and 12.4% in 2018. The overall prevalence of prediabetes was 35.7% in 2013 and 38.1% in 2018; this increase in prevalence was not statistically significant. Interestingly, only 36.7% of adults reported knowing about their diabetes diagnosis at the time of the survey in 2018. There was no significant change in the proportion of individuals being treated for diabetes between 2013 and 2018. Women were found to have a significantly lower prevalence of diabetes and prediabetes than men in both survey years. This study demonstrated that diabetes and prediabetes are becoming increasingly prevalent in China, with a statistically significant increase in disease prevalence after even a 5 year period. Wang et al report that despite high disease prevalence, the proportion of patients receiving treatment for diabetes remains low, as does general awareness about the disease and how it can be managed. A strength of this study was the large population size and reproducible methodology. A primary limitation of this work is the reliance on self-reported data for some demographic and social information. Additionally, the cross-sectional nature of this study does not control for possible confounding variables, and makes it difficult to ascertain details regarding diet which are important for the development and management of diabetes.

Click to read this study in JAMA

Relevant Reading: Complications of diabetes in China: health system and economic implications

In-Depth [cross-sectional study]: Data for this study were derived from the China Chronic Disease and Risk Factors Surveillance study, a nation-wide research effort initiated in 2004 to understand the risk of chronic, noncommunicable disease in China. Survey data from the periods of June 2013 to May 2014, and August 2018 to August 2019 were collected. Participants were noninstitutionalized Chinese adults (aged 18 or older) who had lived in their place of residence for at least 6 months. Notably, pregnant women were excluded. Anthropomorphic measurements were collected by trained staff, and plasma glucose levels were assessed 2 hours following standard oral glucose tolerance testing procedures. Diabetes and prediabetes were defined in accordance with the American Diabetes Association criteria. The reported prevalence of diabetes amongst the study sample waas 10.9% in 2013 (95% confidence interval [CI] 10.4-11.5%) and 12.4% in 2018 (95% CI 11.8-13.0%). This increase in diabetes prevalence was considered statistically significant, with p<0.001. The prevalence of prediabetes in 2013 was 35.7% (95% CI 34.2-37.3%) and was 38.1% (95% CI 36.4-39.7%) in 2018 (p= 0.07). The prevalence of adults who knew about their diabetic status was 4.5% (95% CI 4.2-4.8%). The estimated prevalence of diabetes by gender was as follows: in 2013, 10.2% (95% CI 9.7-10.7%) of women and 11.7% (11.0-12.4%) of men, and in 2018, 11.5% (10.8-12.2%) of women and 13.3% (12.6-14.0%) of men. In 2018, 36.7% (34.7-38.6%) of patients with diabetes knew about their diagnosis, and 32.9% (30.9-34.8%) were receiving treatment. Women were more likely to know about their diagnosis, and be receiving treatment, than men were (p<0.001).

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