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Increased Prevalence in Diabetes Among Chinese Adults

Studies show that half of Chinese adults have an increased risk for prediabetes and diabetes; Tibetan and Muslim Chinese at lowest risk.

Diabetes has been growing drastically throughout the years, serving as one of the major risk factors of morbidity and mortality among various individuals. Diabetes is a risk factor for several disease states, which include but are not limited to ischemic heart disease, stroke, chronic kidney disease and myocardial infarctions. As one of the largest countries in the world, China contributes to this increase in morbidity and mortality and moreover diabetes pandemic. The prevalence of diabetes in China has been increasing since 1980 from less than 1% to 9.7% with approximately 92.4 million adults in China affected. As such, adults in China with diabetes are prone to losing, on average, nine years of life compared to those who do not have diabetes.

In the study titled Half of Chinese Adults Have Pre-diabetes or Diabetes, researchers estimated the prevalence of prediabetes and diabetes in Chinese adults. A cross-sectional study was conducted in several parts of China, using 170,287 participants, aged 18 years or older. Glycemic control was measured using fasting plasma glucose and hemoglobin A1c for those who have diabetes and a 2-hour oral glucose for individuals without diabetes. Main outcomes and measures were assessed using total diabetes and prediabetes as primary outcomes, in addition to awareness and treatment measures to diabetes. Approximately 36.5% participants with diabetes were aware of their diagnosis, 32.2% of individuals with diabetes were treated and 49.2% had good glycemic control. According to the 2010 American Diabetes Association criteria, individuals with hemoglobin A1c level less than 7.0% were considered to have adequate glycemic control. Participants included Tibetan, Zhuang, Manchu, Uyghur, and Muslim Chinese adults compared with Han Chinese.

With respect to the 2013 China Chronic Disease and Risk Factors Surveillance Study conducted every 3 years, Chinese adults are more at risk for developing diabetes at a lower BMI when compared to Americans with diabetes (24.0 vs. 28.7, respectively). However, the number of overweight Chinese participants with diabetes was similar to Americans. Researchers also indicate that the many ethnic groups in China have differences in genetics, culture and socioeconomic conditions, which contribute to variations in the prevalence of diabetes among ethnic groups. Results show that Tibetan and Muslim Chinese had a significantly lower rate of developing prediabetes and diabetes when compared to Han participants (P<.001). In addition, adjusted odds ratio were also taken into consideration between the different ethnic groups; 0.42 for Hans Chinese with diabetes, 0.77 for pre-diabetes in Tibetan Chinese, and 0.73 for diabetes and 0.78 for pre-diabetes in Muslim Chinese.  In addition, among the entire Chinese population studied, the estimated prevalence of those diagnosed with diabetes and those undiagnosed was 10.9% and 4.0%, respectively with a CI of 95%. Prediabetes prevalence was estimated to be 35.7% and had a 95% CI.  Individuals with diabetes who knew of their diagnosis were estimated around 32.2% with a 95% CI.

Approximately 49.2% individuals were treated and had adequate glycemic control.

Researchers state that more information is needed to study the impact of cultural differences with respect to diabetes and prediabetes prevalence. They believe that two genes involved with oxygen processing are significant in Tibetan Chinese due to their residence in high-altitude locations. In return, this contributes to their lower BMIs when compared with other ethnic Chinese groups. Moreover because of the way Tibetans live, they are more physically active than most other Chinese, which also contributes to their lower BMI. However, Tibetan Chinese are also known to eat more meat than fruits and vegetables, as well as, drink large amounts of tea with salt and butter.

This large cross-sectional study emphasizes that diabetes has become a major pandemic in China. According to the study, approximately 10.9% of Chinese adults were diagnosed with diabetes, 4.0% were undiagnosed, and 35.7% were diagnosed eith prediabetes. These results suggest that a large portion of the Chinese adult population may have had prediabetes, a major risk factor to various disease states like overt diabetes and cardiovascular disease. Diabetes continues to be a major risk factor for morbidity and mortality. As such, high blood glucose levels account for the majority of deaths associated with ischemic heart disease, cardiovascular disease, chronic kidney disease, and blindness in many countries. Furthermore, the study shows that although the prevalence of diabetes is low, the estimated prevalence of prediabetes is more common in underdeveloped regions of the world.

Practice Pearls:

  • Diabetes is one of the leading causes of morbidity and mortality worldwide.
  • The prevalence of diabetes and prediabetes has been steadily rising in the Chinese population.
  • Among ethnic groups studies, Tibetan and Muslim Chinese have lower BMIs and are at a lower risk for developing diabetes and prediabetes among their counterparts.

References:

Wang, MPH Limin. “Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China.” JAMA. American Medical Association, 27 June 2017. ScienceDaily. ScienceDaily, n.d. Web. 04 July 2017.

 

Nuha Awad, Doctor of Pharmacy Candidate: Class of 2018; LECOM College of Pharmacy