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      Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013

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          Key Points

          Question

          What is the prevalence of diabetes and prediabetes in China?

          Findings

          In this nationally representative cross-sectional survey conducted in 2013 in mainland China with 170 287 participants, the estimated overall prevalence of total diabetes was 10.9%; of prediabetes, 35.7%. Tibetan and Muslim Chinese individuals had significantly lower prevalence of diabetes than Han participants.

          Meaning

          The estimated prevalence of diabetes and prediabetes in China differs by ethnic group, and the estimated overall high prevalence may be associated with different methods of measuring hemoglobin A 1c.

          Abstract

          Importance

          Previous studies have shown increasing prevalence of diabetes in China, which now has the world’s largest diabetes epidemic.

          Objectives

          To estimate the recent prevalence and to investigate the ethnic variation of diabetes and prediabetes in the Chinese adult population.

          Design, Setting, and Participants

          A nationally representative cross-sectional survey in 2013 in mainland China, which consisted of 170 287 participants.

          Exposures

          Fasting plasma glucose and hemoglobin A 1c levels were measured for all participants. A 2-hour oral glucose tolerance test was conducted for all participants without diagnosed diabetes.

          Main Outcomes and Measures

          Primary outcomes were total diabetes and prediabetes defined according to the 2010 American Diabetes Association criteria. Awareness and treatment were also evaluated. Hemoglobin A 1c concentration of less than 7.0% among treated diabetes patients was considered adequate glycemic control. Minority ethnic groups in China with at least 1000 participants (Tibetan, Zhuang, Manchu, Uyghur, and Muslim) were compared with Han participants.

          Results

          Among the Chinese adult population, the estimated standardized prevalence of total diagnosed and undiagnosed diabetes was 10.9% (95% CI, 10.4%-11.5%); that of diagnosed diabetes, 4.0% (95% CI, 3.6%-4.3%); and that of prediabetes, 35.7% (95% CI, 34.1%-37.4%). Among persons with diabetes, 36.5% (95% CI, 34.3%-38.6%) were aware of their diagnosis and 32.2% (95% CI, 30.1%-34.2%) were treated; 49.2% (95% CI, 46.9%-51.5%) of patients treated had adequate glycemic control. Tibetan and Muslim Chinese had significantly lower crude prevalence of diabetes than Han participants (14.7% [95% CI, 14.6%-14.9%] for Han, 4.3% [95% CI, 3.5%-5.0%] for Tibetan, and 10.6% [95% CI, 9.3%-11.9%] for Muslim; P < .001 for Tibetan and Muslim compared with Han). In the multivariable logistic models, the adjusted odds ratios compared with Han participants were 0.42 (95% CI, 0.35-0.50) for diabetes and 0.77 (95% CI, 0.71-0.84) for prediabetes for Tibetan Chinese and 0.73 (95% CI, 0.63-0.85) for diabetes and 0.78 (95% CI, 0.71-0.86) for prediabetes in Muslim Chinese.

          Conclusions and Relevance

          Among adults in China, the estimated overall prevalence of diabetes was 10.9%, and that for prediabetes was 35.7%. Differences from previous estimates for 2010 may be due to an alternate method of measuring hemoglobin A 1c.

          Abstract

          This population epidemiology study uses national survey data to estimate the prevalence and ethnic patterns of diabetes and prediabetes in China in 2013.

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          Author and article information

          Journal
          JAMA
          JAMA
          JAMA
          JAMA
          American Medical Association
          0098-7484
          1538-3598
          27 June 2017
          27 June 2017
          27 December 2017
          : 317
          : 24
          : 2515-2523
          Affiliations
          [1 ]National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
          [2 ]Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
          Author notes
          Article Information
          Corresponding Authors: Linhong Wang, PhD, National Center for Chronic Non-communicable Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China ( linhong@ 123456chinawch.org.cn ); Yonghua Hu, MD, Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China ( yhhu@ 123456bjmu.edu.cn ).
          Accepted for Publication: May 29, 2017.
          Author Contributions: Drs Limin Wang and Linhong Wang had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
          Concept and design: Limin Wang, Gao, D. Zhang, Deng, Linhong Wang, Hu.
          Acquisition, analysis, or interpretation of data: All authors.
          Drafting of the manuscript: Limin Wang, Gao, D. Zhang, Qin, Jin.
          Critical revision of the manuscript for important intellectual content: Limin Wang, Gao, M. Zhang, Huang, Deng, Li, Zhao, Zhou, Tang, Linhong Wang, Hu.
          Statistical analysis: Limin Wang, Gao, M. Zhang, Li, Zhao.
          Obtained funding: Limin Wang, Gao, Zhou, Linhong Wang, Hu.
          Administrative, technical, or material support: Limin Wang, M. Zhang, Huang, D. Zhang, Deng, Li, Zhao, Jin, Zhou, Linhong Wang, Hu.
          Supervision: Limin Wang, Gao, Zhou, Linhong Wang, Hu.
          Drs Limin Wang and Gao contributed equally as first authors. Drs Linhong Wang and Hu contributed equally as corresponding authors.
          Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Gao reports receiving a grant from the Recruitment Program for Young Professionals in China. No other disclosures were reported.
          Funding/Support: This study was supported by the Chinese central government (key project of public health program) and the National Natural Science Foundation of China (grants 81473043, 81230066, and 91546120).
          Role of the Funder/Sponsor: None of the funding organizations were involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.
          Article
          PMC5815077 PMC5815077 5815077 joi170067
          10.1001/jama.2017.7596
          5815077
          28655017
          472b0eb7-1020-41ed-a7c7-b91b90978152
          Copyright 2017 American Medical Association. All Rights Reserved.
          History
          : 9 October 2016
          : 12 May 2017
          : 29 May 2017
          Funding
          Funded by: National Natural Science Foundation of China
          Categories
          Research
          Research
          Original Investigation

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