Diabetes is a chronic health condition characterized by elevated blood sugar (glucose). It occurs when the pancreas doesn’t produce enough insulin, or the body cannot effectively use the insulin it produces. Insulin, a hormone, allows glucose from food to enter cells for energy. Without sufficient insulin, glucose accumulates in the bloodstream, leading to hyperglycemia, which can damage organs and tissues over time.
Globally, diabetes affects hundreds of millions of people, a leading noncommunicable disease with increasing prevalence. It requires ongoing management to prevent severe complications, impacting individual health and healthcare systems.
The Scale of Diabetes in China
China faces a substantial diabetes burden, having the largest number of individuals with the condition globally. In 2018, adult diabetes prevalence was 12.4%, up from less than 1% in 1980. This translates to approximately 140 million people aged 20–79 years, over a quarter of the global diabetic population. The rapid rise in cases has been described as “explosive” over the past few decades.
Many individuals remain undiagnosed. In 2013, only 3.5% of those surveyed had a previous diagnosis, with an undiagnosed prevalence rate of 8.1%. By 2018, awareness was 36.7% and treatment 32.9%, indicating a persistent gap in diagnosis and care. The large number of individuals in the prediabetes stage, estimated at 38.1% in 2018, further signals a potential for continued increase in diabetes cases.
The epidemic affects various demographic groups, with a trend towards younger onset. While prevalence generally increases with age, significant rates are observed in younger adults, such as 5.0% in the 18–29 age group and 6.5% in the 30–39 age group. Urban residents and those in economically developed regions tend to have higher prevalence rates. The escalating number of cases places a considerable strain on China’s public health infrastructure.
Unique Influencing Factors
China’s rapid urbanization has significantly contributed to the rising rates of diabetes. As populations shifted from rural to urban areas, lifestyle changes became widespread. This transition often involves more sedentary behaviors, such as reduced physical activity, and increased consumption of processed foods high in sugar and fat. These dietary and lifestyle shifts lead to increased rates of overweight and obesity, which are major risk factors for type 2 diabetes.
The “nutritional transition” further exacerbates the issue. Historically, the Chinese diet was rich in grains and vegetables. Economic development has led to increased consumption of animal products, caloric sweeteners, and energy-dense foods, while fiber intake has decreased. This shift from a traditional diet to one resembling Western patterns contributes to the higher prevalence of diet-related non-communicable diseases, including diabetes.
Genetic predispositions also play a role in the high susceptibility of East Asian populations to type 2 diabetes. Studies have identified specific genetic variants associated with type 2 diabetes in people of East Asian descent that were not previously found in European populations. These genetic factors may mean that East Asians can develop the condition at a younger age and at higher incidence rates even with less weight gain compared to European populations. This suggests that individuals with a higher genetic risk may experience a faster decline in beta-cell function, which impacts insulin production.
National Strategies for Control
Recognizing the growing challenge, the Chinese government has initiated various national strategies to address the diabetes epidemic. These efforts are part of broader health system reforms aimed at integrating health promotion, disease prevention, and treatment. The “Healthy China 2030” blueprint includes the Diabetes Prevention and Treatment Initiative as one of its major components.
Government initiatives focus on public health campaigns to raise awareness and promote healthier lifestyles. Goals include achieving a diabetes awareness rate of at least 60% among adults aged 18 and above by 2030. Efforts are also underway to expand screening programs and improve the standardized management rate of type 2 diabetes patients at the local level to at least 70% by 2030.
Improvements in healthcare infrastructure and access for diabetes management are also priorities. This includes strengthening primary healthcare capacity and promoting a tiered service delivery system, ensuring better utilization of health resources across different levels of medical institutions. Training for healthcare professionals, particularly general practitioners, is emphasized to enhance their knowledge and skills in diabetes management. National guidelines for diagnosis and treatment are being implemented to ensure consistent and effective care.
Broader Societal Impact
The widespread prevalence of diabetes in China imposes a significant economic burden. Healthcare costs for diabetes and its complications are substantial, with annual diabetes-related health expenditures reaching approximately $165.3 billion in 2023. The average annual cost per patient increased from $1,292.72 in 2014 to $2,092.87 in 2019, reflecting a rising trend in the economic impact. Projections indicate that total diabetes costs could increase from $250.2 billion in 2020 to $460.4 billion by 2030.
Beyond direct medical costs, lost productivity due to diabetes and its complications contributes to economic strain. The increasing incidence among the working-age population severely impacts societal productivity, affecting individuals, families, and the national economy.
The healthcare system faces considerable challenges in providing adequate care for such a large patient population. The high proportion of undiagnosed cases and the relatively low rates of awareness and treatment further complicate management efforts. The rising number of diabetes cases, coupled with an aging population, strains existing medical resources and infrastructure. This necessitates greater public awareness and education to encourage early detection and management.