Diabetes: What Really Ails China

China's struggle with diabetes has reached epidemic proportions. This is the conclusion of a group of researchers from Tulane University, whose findings were recently published in the New England Journal of Medicine, one of the United States' most prestigious medical journals.

According to the study, 92.4 million adults in China age 20 or older (almost 10% of the population) have diabetes, and 148.2 million adults have pre-diabetes, a condition that is a key risk factor for developing overt diabetes and/or cardiovascular disease. Of particular significance is the finding that the majority of cases of diabetes are undiagnosed and untreated.

These new figures indicate that China has edged ahead of India to become the country with the largest population of diabetics in the world. Most cases of diabetes are from so-called type two diabetes, a form of the disease that accounts for 90-95% of all diabetes cases among adults. It results from insulin resistance and is sometimes combined with an absolute insulin deficiency.

The diabetes epidemic is not only a serious public health problem — it can also have serious economic repercussions. A study found that estimated medical costs for diabetes and its complications were 18.2% of China's total health expenditures in 2007. The World Health Organization (WHO) estimates that diabetes, heart disease and stroke will cost China approximately $558 billion between 2006 and 2015.

Until just over a decade ago, diabetes was relatively rare in China. However, in the last decade the problem has become much more severe. Experts believe that China's rapid economic development — and the increased urbanization, physical inactivity, unhealthy diet and obesity that often accompany increased prosperity — is an important contributing factor in the development of the disease.

Environmental toxins may also contribute to recent increases in the rate of type two diabetes. This is the opinion of some experts, who found a positive correlation between the concentration in the urine of bisphenol A, a constituent of some plastics, and the incidence of type two diabetes.

Obesity has been found to contribute approximately 55% to an individual's development of type two diabetes. A study on the importance of lifestyle factors showed that those who had high levels of physical activity, a healthy diet, did not smoke and consumed alcohol only in moderation had an 82% lower rate of diabetes. When a normal weight was included, the rate was 89% lower.

The increased rate of childhood obesity between 1960 and 2000 is believed to have led to the increase of type two diabetes in children and adolescents. There were more than 60 million obese people in China, and another 200 million who were overweight, according to a 2004 nationwide survey.

In the United States, type two diabetes affects approximately 8% of adults. That proportion increases to 18.3% among Americans age 60 and older, according to statistics from the American Diabetes Association. In comparison, the worldwide prevalence of diabetes among all age groups was estimated to be 2.8% in 2000, and will rise to 4.4% in 2030.

Diabetes and its consequences have become a major public health problem not only in China, but in many industrialized countries as well. To avoid further damage to people's health, it is imperative to develop and institute national strategies for preventing, detecting and treating diabetes in the general population.