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

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          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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          Most cited references 16

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          Overweight and obesity in China.

           Yangfeng Wu (2006)
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            Exposure to the Chinese Famine in Early Life and the Risk of Hyperglycemia and Type 2 Diabetes in Adulthood

             Yanping Li,  Yuna He,  Lu Qi (2010)
            OBJECTIVE Early developmental adaptations in response to undernutrition may play an essential role in susceptibility to type 2 diabetes, particularly for those experiencing a “mismatched rich nutritional environment” in later life. We examined the associations of exposure to the Chinese famine (1959–1961) during fetal life and childhood with the risk of hyperglycemia and type 2 diabetes in adulthood. RESEARCH DESIGN AND METHODS We used the data for 7,874 rural adults born between 1954 and 1964 in selected communities from the cross-sectional 2002 China National Nutrition and Health Survey. Hyperglycemia was defined as fasting plasma glucose ≥6.1 mmol/l and/or 2-h plasma glucose ≥7.8 mmol/l and/or a previous clinical diagnosis of type 2 diabetes. RESULTS Prevalences of hyperglycemia among adults in nonexposed, fetal exposed, early-childhood, mid-childhood, and late-childhood exposed cohorts were 2.4%, 5.7%, 3.9%, 3.4%, and 5.9%, respectively. In severely affected famine areas, fetal-exposed subjects had an increased risk of hyperglycemia compared with nonexposed subjects (odds ratio = 3.92; 95% CI: 1.64–9.39; P = 0.002); this difference was not observed in less severely affected famine areas (odds ratio = 0.57; 95% CI: 0.25–1.31; P = 0.185). The odds ratios were significantly different between groups from the severe and less severe famine areas (P for interaction = 0.001). In severely affected famine areas, fetal-exposed subjects who followed an affluent/Western dietary pattern (odds ratios = 7.63; 95% CI: 2.41–24.1; P = 0.0005) or who had a higher economic status in later life experienced a substantially elevated risk of hyperglycemia (odds ratios = 6.20; 95% CI: 2.08–18.5; P = 0.001). CONCLUSIONS Fetal exposure to the severe Chinese famine increases the risk of hyperglycemia in adulthood. This association appears to be exacerbated by a nutritionally rich environment in later life.
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              Diabetes in China: a societal solution for a personal challenge.

              China has a large burden of diabetes: in 2013, one in four people with diabetes worldwide were in China, where 11·6% of adults had diabetes and 50·1% had prediabetes. Many were undiagnosed, untreated, or uncontrolled. This epidemic is the result of rapid societal transition that has led to an obesogenic environment against a backdrop of traditional lifestyle and periods of famine, which together puts Chinese people at high risk of diabetes and multiple morbidities. Societal determinants including social disparity and psychosocial stress interact with factors such as low-grade infection, environmental pollution, care fragmentation, health illiteracy, suboptimal self-care, and insufficient community support to give rise to diverse subphenotypes and consequences, notably renal dysfunction and cancer. In the China National Plan for Non-Communicable Disease Prevention and Treatment (2012-15), the Chinese Government proposed use of public measures, multisectoral collaborations, and social mobilisation to create a health-enabling environment and to reform the health-care system. While awaiting results from these long-term strategies, we advocate the use of a targeted and proactive approach to identify people at high risk of diabetes for prevention, and of private-public-community partnerships that make integrated care more accessible and sustainable, focusing on registry, empowerment, and community support. The multifaceted nature of the societal and personal challenge of diabetes requires a multidimensional solution for prevention in order to reduce the growing disease burden.
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                Author and article information

                Contributors
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                Journal
                BMJ
                BMJ
                BMJ-UK
                bmj
                The BMJ
                BMJ Publishing Group Ltd.
                0959-8138
                1756-1833
                2020
                28 April 2020
                : 369
                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 ]Division of Endocrinology, Department of Internal Medicine, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
                [3 ]Department of Endocrinology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
                [4 ]Department of Endocrinology, Hainan General Hospital, Haikou, Hainan, China
                [5 ]Department of Endocrinology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shannxi, China
                [6 ]Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
                [7 ]Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
                [8 ]Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, China
                [9 ]Department of Endocrinology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
                [10 ]Department of Endocrinology, Cardiovascular and Cerebrovascular Disease Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China, 750004
                [11 ]Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
                [12 ]Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
                [13 ]Department of Endocrinology, Hohhot First Hospital, Hohhot, Inner Mongolia, China
                [14 ]Department of Endocrinology and Metabolism, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
                [15 ]Research Centre of Endocrine and Metabolic Diseases, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
                [16 ]Department of Endocrinology and Metabolism, Fujian Institute of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
                [17 ]Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou, Gansu, China
                [18 ]Department of Endocrinology and Metabolism, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
                [19 ]Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, Jilin, China
                [20 ]Department of Endocrinology, Shanghai University of Medicine and Health Science Affiliated Zhoupu Hospital, Shanghai, China
                [21 ]Department of Endocrinology, First Hospital of An Hui Medical University, Hefei, Anhui, China
                [22 ]Department of Endocrinology, First People's Hospital of Yunnan Province, Kunming, Yunnan, China
                [23 ]Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
                [24 ]Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
                [25 ]Department of Endocrinology and Metabolism, People’s Hospital of Tibet Autonomous Region, Lhasa, Tibet, China
                [26 ]Department of Endocrinology, Qinghai Provincial People's Hospital, Xining, Qinghai, China
                [27 ]Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, China
                [28 ]Department of Endocrinology and Metabolism, Affiliated Hospital of Guiyang Medical University, Guiyang, Guizhou, China
                [29 ]Department of Endocrinology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
                [30 ]Department of Endocrinology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
                [31 ]Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
                [32 ]Department of Endocrinology and Metabolism and the Institute of Endocrinology, Rui-Jin Hospital affiliated with Shanghai Jiao-Tong University School of Medicine, Shanghai, China
                [33 ]Department of Endocrinology, Shandong Provincial Hospital affiliated with Shandong University, Jinan, Shandong, China
                Author notes
                Correspondence to: W Teng twp@ 123456vip.163.com
                Article
                liyo054529
                10.1136/bmj.m997
                7186854
                32345662
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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