. 2020 Apr 28:369:m997.

doi: 10.1136/bmj.m997.

Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study

Yongze Li¹, Di Teng², Xiaoguang Shi¹, Guijun Qin³, Yingfen Qin⁴, Huibiao Quan⁵, Bingyin Shi⁶, Hui Sun⁷, Jianming Ba⁸, Bing Chen⁹, Jianling Du¹⁰, Lanjie He¹¹, Xiaoyang Lai¹², Yanbo Li¹³, Haiyi Chi¹⁴, Eryuan Liao¹⁵, Chao Liu¹⁶, Libin Liu¹⁷, Xulei Tang¹⁸, Nanwei Tong¹⁹, Guixia Wang²⁰, Jin-An Zhang²¹, Youmin Wang²², Yuanming Xue²³, Li Yan²⁴, Jing Yang²⁵, Lihui Yang²⁶, Yongli Yao²⁷, Zhen Ye²⁸, Qiao Zhang²⁹, Lihui Zhang³⁰, Jun Zhu³¹, Mei Zhu³², Guang Ning³³, Yiming Mu⁸, Jiajun Zhao³⁴, Weiping Teng², Zhongyan Shan¹

Affiliations

¹ Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, 155 Nanjing Bei Street, Shenyang, 110001, Liaoning, China.
² Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, 155 Nanjing Bei Street, Shenyang, 110001, Liaoning, China twp@vip.163.com.
³ Division of Endocrinology, Department of Internal Medicine, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China.
⁴ Department of Endocrinology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
⁵ Department of Endocrinology, Hainan General Hospital, Haikou, Hainan, China.
⁶ Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi, China.
⁷ Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
⁸ Department of Endocrinology, Chinese PLA General Hospital, Beijing, China.
⁹ Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, China.
¹⁰ Department of Endocrinology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
¹¹ Department of Endocrinology, Cardiovascular and Cerebrovascular Disease Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China, 750004.
¹² Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
¹³ Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
¹⁴ Department of Endocrinology, Hohhot First Hospital, Hohhot, Inner Mongolia, China.
¹⁵ Department of Endocrinology and Metabolism, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
¹⁶ Research Centre of Endocrine and Metabolic Diseases, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
¹⁷ Department of Endocrinology and Metabolism, Fujian Institute of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
¹⁸ Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou, Gansu, China.
¹⁹ Department of Endocrinology and Metabolism, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
²⁰ Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, Jilin, China.
²¹ Department of Endocrinology, Shanghai University of Medicine and Health Science Affiliated Zhoupu Hospital, Shanghai, China.
²² Department of Endocrinology, First Hospital of An Hui Medical University, Hefei, Anhui, China.
²³ Department of Endocrinology, First People's Hospital of Yunnan Province, Kunming, Yunnan, China.
²⁴ Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
²⁵ Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
²⁶ Department of Endocrinology and Metabolism, People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China.
²⁷ Department of Endocrinology, Qinghai Provincial People's Hospital, Xining, Qinghai, China.
²⁸ Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, China.
²⁹ Department of Endocrinology and Metabolism, Affiliated Hospital of Guiyang Medical University, Guiyang, Guizhou, China.
³⁰ Department of Endocrinology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
³¹ Department of Endocrinology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
³² Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China.
³³ Department of Endocrinology and Metabolism and the Institute of Endocrinology, Rui-Jin Hospital affiliated with Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
³⁴ Department of Endocrinology, Shandong Provincial Hospital affiliated with Shandong University, Jinan, Shandong, China.

PMID: 32345662
PMCID: PMC7186854
DOI: 10.1136/bmj.m997

Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study

Yongze Li et al. BMJ. 2020.

. 2020 Apr 28:369:m997.

doi: 10.1136/bmj.m997.

Authors

Affiliations

¹ Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, 155 Nanjing Bei Street, Shenyang, 110001, Liaoning, China.
² Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, 155 Nanjing Bei Street, Shenyang, 110001, Liaoning, China twp@vip.163.com.
³ Division of Endocrinology, Department of Internal Medicine, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China.
⁴ Department of Endocrinology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
⁵ Department of Endocrinology, Hainan General Hospital, Haikou, Hainan, China.
⁶ Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi, China.
⁷ Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
⁸ Department of Endocrinology, Chinese PLA General Hospital, Beijing, China.
⁹ Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, China.
¹⁰ Department of Endocrinology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
¹¹ Department of Endocrinology, Cardiovascular and Cerebrovascular Disease Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China, 750004.
¹² Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
¹³ Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
¹⁴ Department of Endocrinology, Hohhot First Hospital, Hohhot, Inner Mongolia, China.
¹⁵ Department of Endocrinology and Metabolism, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
¹⁶ Research Centre of Endocrine and Metabolic Diseases, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
¹⁷ Department of Endocrinology and Metabolism, Fujian Institute of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
¹⁸ Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou, Gansu, China.
¹⁹ Department of Endocrinology and Metabolism, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
²⁰ Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, Jilin, China.
²¹ Department of Endocrinology, Shanghai University of Medicine and Health Science Affiliated Zhoupu Hospital, Shanghai, China.
²² Department of Endocrinology, First Hospital of An Hui Medical University, Hefei, Anhui, China.
²³ Department of Endocrinology, First People's Hospital of Yunnan Province, Kunming, Yunnan, China.
²⁴ Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
²⁵ Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
²⁶ Department of Endocrinology and Metabolism, People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China.
²⁷ Department of Endocrinology, Qinghai Provincial People's Hospital, Xining, Qinghai, China.
²⁸ Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, China.
²⁹ Department of Endocrinology and Metabolism, Affiliated Hospital of Guiyang Medical University, Guiyang, Guizhou, China.
³⁰ Department of Endocrinology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
³¹ Department of Endocrinology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
³² Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China.
³³ Department of Endocrinology and Metabolism and the Institute of Endocrinology, Rui-Jin Hospital affiliated with Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
³⁴ Department of Endocrinology, Shandong Provincial Hospital affiliated with Shandong University, Jinan, Shandong, China.

PMID: 32345662
PMCID: PMC7186854
DOI: 10.1136/bmj.m997

Abstract

Objective: To assess the prevalence of diabetes and its risk factors.

Design: Population based, cross sectional study.

Setting: 31 provinces in mainland China with nationally representative cross sectional data from 2015 to 2017.

Participants: 75 880 participants aged 18 and older-a nationally representative sample of the mainland Chinese population.

Main outcome measures: Prevalence of diabetes among adults living in China, and the prevalence by sex, regions, and ethnic groups, estimated by the 2018 American Diabetes Association (ADA) and the World Health Organization diagnostic criteria. Demographic characteristics, lifestyle, and history of disease were recorded by participants on a questionnaire. Anthropometric and clinical assessments were made of serum concentrations of fasting plasma glucose (one measurement), two hour plasma glucose, and glycated haemoglobin (HbA_1c).

Results: The weighted prevalence of total diabetes (n=9772), self-reported diabetes (n=4464), newly diagnosed diabetes (n=5308), and prediabetes (n=27 230) diagnosed by the ADA criteria were 12.8% (95% confidence interval 12.0% to 13.6%), 6.0% (5.4% to 6.7%), 6.8% (6.1% to 7.4%), and 35.2% (33.5% to 37.0%), respectively, among adults living in China. The weighted prevalence of total diabetes was higher among adults aged 50 and older and among men. The prevalence of total diabetes in 31 provinces ranged from 6.2% in Guizhou to 19.9% in Inner Mongolia. Han ethnicity had the highest prevalence of diabetes (12.8%) and Hui ethnicity had the lowest (6.3%) among five investigated ethnicities. The weighted prevalence of total diabetes (n=8385) using the WHO criteria was 11.2% (95% confidence interval 10.5% to 11.9%).

Conclusion: The prevalence of diabetes has increased slightly from 2007 to 2017 among adults living in China. The findings indicate that diabetes is an important public health problem in China.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: funding for the project through a grant (15010010589) from the Chinese Medical Association; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

**Fig 1**
Prevalence, awareness, treatment, and control of diabetes diagnosed by the American Diabetes Association criteria among study participants

See this image and copyright information in PMC

References

1. DeFronzo RA, Ferrannini E, Zimmet P, et al. International textbook of diabetes mellitus, two volume set. 4th ed Wiley-Blackwell, 2015. 10.1002/9781118387658 . - DOI
1. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1211-59. 10.1016/S0140-6736(17)32154-2 - DOI - PMC - PubMed
1. NCD Risk Factor Collaboration (NCD-RisC) Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet 2016;387:1513-30. 10.1016/S0140-6736(16)00618-8 - DOI - PMC - PubMed
1. American Diabetes Association Classification and diagnosis of diabetes: standards of medical care in diabetes—2018. Diabetes Care 2018;41(Suppl 1):S13-27. 10.2337/dc18-S002 - DOI - PubMed
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Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study

Affiliations

Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous