The Highest Prevalence of Diabetes Recorded in Mainland China: A National Epidemiologic Survey

Background: Along with rapid socioeconomic development and change of lifestyle, the diabetes epidemic in China may be in a state of transition. We conducted this study to assess the current prevalence of diabetes and risk factors in China, as well as the national trend in diabetes prevalence. Methods: A nationally representative cross-sectional sample of 75,880 participants aged 18 or older was enrolled from all 31 provincial regions of mainland China. The participants were given a questionnaire and an anthropometric and clinical assessment. Serum concentrations of fasting plasma glucose, 2-hour plasma glucose and HbA1c were measured. Findings: The weighted prevalence of total diabetes, newly diagnosed diabetes and prediabetes was 12*75% (95% CI, 11*97% to 13*56%), 6.74% (95% CI, 6*14% to 7*40%) and 35*22% (95% CI, 33*51% to 36*97%), respectively, among the general Chinese population aged 18 years or older. The annual percentage change in diabetes prevalence was 1*5% (95% CI, 0*2% to 3*0%, p<0*0001) from 2007 to 2017. Men had a higher prevalence of diabetes than did women (13*71% vs. 11*76%, p<0*0001). The prevalence of diabetes was shown to increase sharply after 50 years of age which born around 1960's. Diabetes prevalence ranged from 6*20% in Guizhou (95% CI, 2*89% to 12*83%) to 19*85% in Inner Mongolia (95% CI, 17*55% to 22*36) in 31 provinces. Han ethnicity had the highest prevalence of diabetes (12*82%, 95% CI, 12*03% to 13*66%), and Hui was the lowest (6*26%, 95% CI, 3*90% to 9*91%) among five investigated ethnicities. Interpretation: The highest recorded prevalence of diabetes was reported, which indicated that the diabetic epidemic in mainland China is still increasing in severity. The increase in prevalence was not mainly attributed to aging and obesity but might be related to genetic susceptibility, prenatal nutrition, urbanization and regional variations. Funding Statement: This work is supported by the Clinical Research Fund of Chinese Medical Association (Grant No. 15010010589). Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: The research protocols were approved by the Medical Ethics Committee of China Medical University. All subjects provided written informed consent following a thorough explanation of the research procedures.