medwireNews: A study published in JAMA highlights the serious consequences of the burgeoning diabetes epidemic in China.
Researcher Zhengming Chen (University of Oxford, UK) and colleagues note that the prevalence of diabetes in China has more than quadrupled over recent decades. The overall prevalence in this 7-year nationwide study of 512,869 adults was 5.9%, not far behind the estimated 9.3% of Americans with diabetes in 2014.
The prevalence in Chinese people was higher in urban than rural areas, at 8.1% versus 4.1%, but the consequences were worse for rural-living patients. In all, 4.9% of the study cohort died during follow-up, and death was twice as common in those with diabetes as without (1373 vs 646 deaths per 100,000). But the adjusted rate ratio was higher in rural than urban areas, at 2.17 and 1.83, respectively.
In what editorialist Margaret Chan (World Health Organization, Geneva, Switzerland) identifies as “perhaps its most significant contribution,” the study highlights direct causes of diabetes-related mortality that differ from those seen in Western populations. Although diabetes was associated with the expected range of cardiovascular mortality outcomes, it also conferred a twofold increased risk for stroke mortality, with nearly three-quarters of these deaths being from hemorrhagic stroke.
“From the clinical and public health perspectives, the most concerning finding was the high proportion of deaths attributed to diabetic ketoacidosis or coma and chronic kidney disease, mainly related to diabetes rather than other or unspecific kidney disease,” says Chan.
Ten percent of all diabetes deaths were due to diabetic ketoacidosis or coma, and patients also had a 13-fold increased risk for death from chronic kidney disease, mainly accounted for by diabetic kidney disease. Chan notes that these risks were higher in rural than urban areas, and are much higher than those reported in high-income countries.
“The pattern of excess mortality revealed in this study […] points to significant weaknesses in the clinical management of diabetes, especially in rural areas, and in the effectiveness of population-wide interventions aimed at prevention,” she writes.
Although 77% of patients with previously diagnosed diabetes (3.1% of the whole cohort) were using antidiabetic medications at baseline, average glucose levels remained increased. Very few patients were receiving treatment for vascular risk factors such as hypertension.
Chan says that China faces challenges including reliance on hospital-based care, a “severe shortage” of family doctors, and retaining qualified health professionals in rural areas, but notes that the government has embarked on “what is likely the most extensive reform of a health system in modern times.”
And she adds that “China has delivered some stunning public health success stories in the past.”
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