THE DIABETES EPIDEMIC IN CHINA: AN INTEGRATED REVIEW OF NATIONAL SURVEYS

Abstract

Objective: To review trends in the prevalence and incidence of diabetes mellitus (DM) and related risk factors in China.

Methods: We searched the literature using PubMed, China Knowledge Resource Integrated Database, and China Wanfang Digital Database for large epidemiologic studies and national surveys.

Results: During the past 30 years (1980-2010), 7 national diabetes mellitus surveys were conducted in China mainland, indicating that the prevalence of DM has increased 17-fold, from 0.67 to 11.6% of the population. The prevalence of impaired glucose regulation (IGR, including impaired fasting glucose and impaired glucose tolerance) also increased, from 2.09 in 1994 to 27.2% in 2010. There was no national representative study of the incidence of diabetes to date; the reported incidence of type 2 diabetes during past 25 years in several cohort studies varied (2.7 to 15.8 per 1,000 person-years). Potential risk factors which could have contributed to the increasing prevalence and incidence of DM and IGR in the Chinese population include social and economic development, urbanization, dietary pattern, and Westernized lifestyle. Further, genetic studies have suggested that unique inheritable risk factors in the Chinese population may increase the risk for DM when compared to Caucasians.

Conclusion: DM and IGR have become epidemic in China. Public health strategies should focus on modifying lifestyle and dietary factors, particularly among those with a susceptible genetic background.

Abbreviations: BMI = body mass index DM = diabetes mellitus FBG = fasting blood glucose GWAS = genome-wide association study IGR = impaired glucose regulation IGT = impaired glucose tolerance OGTT = oral glucose tolerance test T2D = type 2 diabetes WC = waist circumference WHR = waist-hip ratio.

Figure 1

Prevalence and its 95% confidence intervalof diabetes mellitus (DM) and impaired glucose regulation (IGR) of China. IGR referred impaired glucose tolerance by WHO criteria (in the 1994,1995 and 2007 surveys) or impaired fasting glucose by ADA criteria (in the 2001,2002,2010 surveys) (Note: the detailed diagnosis criteria of DM and IGR used in the 7 studies were described in table 2)

Figure 2

Prevalence trend for diabetes mellitus (DM) (panel A) and impaired glucose regulation (IGR) (Panel B) in China, in each age group ( Note: the detailed diagnosis criteria of DM and IGR used in the 7 studies were described in table 2 )

Figure 3

Prevalenceof diabetes mellitus (DM) (panel A) and impaired glucose regulation (IGR) (Panel B) in China, according to sex (Note: the detailed diagnosis criteria of DM and IGR used in the 7 studies were described in table 2)

Figure 4

Prevalence of diabetes mellitus (DM) and impaired glucose regulation (IGR) in urban and rural area (Note: the detailed diagnosis criteria of DM and IGR used in the 7 studies were described in table 2)