China has a serious problem with diabetes, which has reached epidemic proportions in the country. This is the conclusion of a group of researchers from Tulane University and colleagues from China, whose findings were published in the prestigious New England Journal of Medicine. Type 2 diabetes accounts for 90 percent to 95 percent of all diabetes cases among adults.

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

These figures indicate that China has edged ahead of India to become the country with the highest number of diabetes-afflicted people. The diabetes epidemic is not only a serious public health problem, but can also have serious economic repercussions as well. A study found that estimated medical costs for diabetes and its complications accounted for 18.2 percent of China’s total health expenditure in 2007. The World Health Organization (WHO) estimates that diabetes, heart disease and stroke will cost China approximately $558 billion between 2006 and 2015.

Experts associate China’s rapid economic development with increased urbanization, physical inactivity and unhealthful diet — all important contributing factors in the development of diabetes. Until just over a decade ago, diabetes was relatively rare in China.

Environmental toxins may also contribute to recent increases in the prevalence of type 2 diabetes. This is the opinion of experts who found a positive correlation between concentration in the urine of bisphenol A, found in some plastics, and type 2 diabetes.

Obesity has been found to contribute to approximately 55 percent of Type 2 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 percent lower chance of developing diabetes.

The increased rate of childhood obesity between 1960 and 2000 is believed to have directly contributed to the increased frequency of type 2 diabetes in children and adolescents. According to a 2004 survey, there were more than 60 million obese people in China, and another 200 million who were overweight.

Type 2 diabetes diabetes is a form of the disease that results from insulin resistance, or when cells fail to use insulin properly. Type 2 diabetes affects approximately 8 percent of adults in the U.S, and 18.3 percent of Americans aged 60 or older, according to the American Diabetes Association. By comparison, the worldwide prevalence of diabetes across all age groups was estimated to be 2.8 percent in 2000, and is expected to rise to 4.4 percent by 2030. Presently, the rate of increase of diabetes is much greater in China than in Europe or the U.S.

Diabetes and its consequences have become a major public health problem, not only in China but in many industrialized countries. It is imperative that, as recommended by the authors of the study of the situation in China, strategies be developed and instituted for preventing, diagnosing and treating diabetes in the general population.

Dr. Cesar Chelala is an international public health consultant.

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