Population-based prevalence of self-reported pediatric diabetes and screening for undiagnosed type 2 diabetes in Chinese children in years 2017-2019, a cross-sectional study

Abstract

Background: The worldwide geographical and temporal variation in the prevalence of diabetes represents a challenge, but also an opportunity for gaining etiological insights. Encompassing the bulk of East Asians, a large and distinct proportion of the world population, China can be a source of valuable epidemiological insights for diabetes, especially in early life, when pathophysiology begins. We carried out a nationwide, epidemiological survey of Prevalence and Risk of Obesity and Diabetes in Youth (PRODY) in China, from 2017 to 2019, to estimate the population-based prevalence of diagnosed pediatric diabetes and screen for undiagnosed pediatric type 2 diabetes (T2D).

Methods: PRODY was a nation-wide, school population-based, cross-sectional, multicenter survey by questionnaire, fasting urine glucose test and simple oral glucose tolerance test (s-OGTT), among a total number of 193,801 general-population children and adolescents (covered a pediatric population of more than 96.8 million), aged 3-18, from twelve provinces across China. The prevalence of the self-reported pediatric diabetes, the proportion of subtypes, the crude prevalence of undiagnosed T2D and prediabetes in general juvenile population and the main risk factors of type 1 (T1D) and type 2 (T2D) diabetes had been analyzed in the study.

Findings: The prevalence of all self-reported pediatric diabetes was estimated at 0.62/1000 (95% CI: 0.51-0.74), with T1D at 0.44/1000 (95% CI: 0.35-0.54) and T2D at 0.18/1000 (95% CI: 0.13-0.25). For undiagnosed T2D, the crude prevalence was almost ten-fold higher, at 1.59/1000, with an estimated extra 28.45/1000 of undiagnosed impaired glucose tolerance (IGT) and 53.74/1000 of undiagnosed impaired fasting glucose (IFG) by s-OGTT screening. Maternal diabetes history is the major risk factors for all subtypes of pediatric diabetes in China.

Interpretation: The PRODY study provides the first population-based estimate of the prevalence of pediatric diabetes China and reveals a magnitude of the problem of undiagnosed pediatric T2D. We propose a practical screening strategy by s-OGTT to address this serious gap.

Funding: The National Key Research and Development Programme of China, Key R&D Program of Zhejiang, the National Natural Science Foundation of China and the Zhejiang Provincial Key Disciplines of Medicine, Key R&D Program Projects in Zhejiang Province.

Keywords: Pediatric diabetes; Prediabetes; Prevalence; Type 1 diabetes; Type 2 diabetes.

Fig. 1

Workflow chart of the PRODY. BMI, body mass index; FUG, fasting urine glucose; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; s-OGTT, simple-oral glucose tolerance test; T1D, type 1 diabetes; T2D, type 2 diabetes.

Fig. 2

Prevalence of pediatric diabetes in China. The self-reported prevalence of pediatric diabetes estimated by questionnaire survey in T1D, T2D (a, b). The proportion of self-reported prevalence of T1D and T2D among all pediatric diabetes by questionnaire survey (c). The proportion of the self-reported prevalence of T1D, T2D by questionnaire survey and of the unknown T2D identified by s-OGTT in high-risk population in the four selected provinces (d). KN, known; T1D, type 1 diabetes; T2D, type 2 diabetes; UKN, unknown.

Fig. 3

Regional distribution of self-reported prevalence of pediatric diabetes in China. a and b is the reginal distribution of pediatric prevalence of T1D and T2D, respectively (case per 1000). The blue color scale represented the intensity of the prevalence. The prevalence of T1D or T2D in each province was listed at the end of each indicatrix. The prevalence of both T1D and T2D displayed in this figure was based on the self-reported prevalence by questionnaire survey; T1D, type 1 diabetes; T2D, type 2 diabetes.

Fig. 4

Family history risk factors for pediatric type 1 diabetes. The risk factors for T1D were analyzed by stepwise Logistic regression and displayed in forest plots. Horizontal bars represent 95% CIs. CI, confidence interval; OR, odds ratio. The diabetes history referred to any type of diabetes had reported for the related family members in questionnaire survey.

Fig. 5

Family history risk factors for pediatric type 2 diabetes. The risk factors for T2D were analyzed by stepwise Logistic regression and displayed in forest plots. Horizontal bars represent 95% CIs. CI, confidence interval; OR, odds ratio. The diabetes history referred to any type of diabetes had reported for the related family members in questionnaire survey.