The 30-year Survey Report On Diabetes in China Is Released: The Mortality Rate Has Dropped Significantly, And The Total Number Of Patients Has Exceeded 117 Million
Oct 17, 2024
With the rapid development of China's economy and the change of residents' lifestyle, diabetes has become a major challenge facing my country's public health field. So, what changes has my country's diabetes epidemiology undergone in the past three decades?
On October 7, 2024, "Analysis of the National Burden and Risk Factors of Diabetes in China from 1990 to 2021: Results of the 2021 Global Burden of Disease Study" was published in the Journal of Diabetes. Data show that in the approximately 30 years from 1990 to 2021, the age-standardized incidence, prevalence and disability-adjusted life years (DALYs) rates of overall diabetes, type 1 diabetes and type 2 diabetes in my country have all shown an overall growth trend, and the diabetes mortality rate has shown a downward trend. Male and elderly patients face a greater disease burden.
In-depth exploration What changes have occurred in diabetes in China in the past 30 years?
The 2021 Diabetes Atlas released by the International Diabetes Federation (IDF) shows that the number of people with diabetes aged 20 to 79 years has reached 537 million worldwide, and is expected to surge to 783 million by 2045. In addition, up to 45% of diabetes cases are still undiagnosed. Diabetes is mainly divided into three types: gestational diabetes, type 1 diabetes and type 2 diabetes. Type 2 diabetes is the most common, accounting for 90% of diabetes cases worldwide.
With the changes in people's lifestyles and eating habits, the prevalence of diabetes in China has continued to rise, from less than 1% in 1980 to 12.4% in 2018. China currently has the largest number of diabetes patients in the world, more than a quarter of the total number of diabetes patients in the world, and about 140 million people aged 20 to 79 are affected by the disease.
Type 2 diabetes is closely related to factors such as urbanization, population aging, overweight and obesity, and genetic susceptibility, among which overweight and obesity are the main risk factors. China's rapid economic growth has brought about changes in lifestyle and eating patterns, leading to a growing obesity problem, which is expected to further increase the burden of diabetes. In addition, the age of onset of diabetes is getting younger, with a prevalence of 5.0% in people aged 18 to 29, 6.5% in people aged 30 to 39, and as high as 11.1% in people aged 40 to 49, which has a serious impact on social productivity. However, there is still a lot of room for improvement in the awareness, treatment and control rates of diabetes in my country. At present, the number of patients with prediabetes is huge, indicating that the prevalence may continue to rise in the future. In 2019, there were nearly 4 million new cases of diabetes in China, and more than 170,000 deaths related to diabetes.
In view of this grim situation, this study used the Global Burden of Disease (GBD) database to analyze the incidence, prevalence and DALYs of type 1 diabetes and type 2 diabetes in China from 1990 to 2021, and calculated the estimated age-standardized rate (ASR) and estimated annual percentage change (EAPC), aiming to fully grasp the current status of diabetes prevention and control in China and provide a scientific basis for future prevention and control work.
DALYs: A comprehensive indicator proposed by the World Health Organization (WHO) and the World Bank in 1990 to evaluate the burden of disease. This indicator uses an objective and quantitative method to comprehensively evaluate the loss of healthy life years caused by premature death or disability due to various diseases.
Epidemiological status The number of diabetes cases, the number of patients, and the number of deaths in China (2021)
In 2021, the number of diabetes cases in China exceeded 4 million (about 4,003,543.82 cases), including 32,000 cases of type 1 diabetes and 3,971,486.24 cases of type 2 diabetes. The age-standardized incidence rates of diabetes, type 1 diabetes, and type 2 diabetes are 244.57/100,000, 2.67/100,000, and 241.9/100,000, respectively.
In 2021, the total number of people with diabetes in China exceeded 117 million (about 117,288,553.93 cases), including 1,442,775.09 cases of type 1 diabetes and 115,845,778.84 cases of type 2 diabetes. The age-standardized prevalence of diabetes, type 1 diabetes, and type 2 diabetes was 6,142.29/100,000, 86.78/100,000, and 6,055.51/100,000, respectively.
In 2021, the number of deaths from diabetes in China was about 178,475.73, and the age-standardized mortality rate was 8.98/100,000.
In 2021, the DALYs caused by diabetes in China were 11,713,613.86, the age-standardized rate was 585.43/100,000, and the annual percentage change was 0.57%. The increase in the burden of disease can be attributed to a variety of factors, including body mass index (BMI), air pollution, and dietary habits.
Past 30 years 1990-2021: Trends in the burden of diabetes in China
1. Over the past 30 years, the incidence of diabetes has shown a significant upward trend
➤ Overall diabetes: From 1990 to 2021, the estimated annual change in the incidence of overall diabetes was 1.10%;
➤ Type 1 diabetes: From 1990 to 2021, the estimated annual change in the incidence of type 1 diabetes was 1.24%;
➤ Type 2 diabetes: From 1990 to 2021, the estimated annual change in the incidence of type 2 diabetes was 1.10%.
2. Over the past 30 years, the "prevalence" of diabetes has shown a significant upward trend
➤ Overall diabetes: From 1990 to 2021, the estimated annual change in the prevalence of overall diabetes was 1.65%;
➤ Type 1 diabetes: From 1990 to 2021, the estimated annual change in the prevalence of type 1 diabetes was 1.27%;
➤ Type 2 diabetes: From 1990 to 2021, the estimated annual change in the prevalence of type 2 diabetes was 1.65%.
3. Over the past 30 years, the "mortality" of diabetes has shown a downward trend
➤ Overall diabetes: From 1990 to 2021, the estimated annual change in overall diabetes-related deaths was -0.33%;
➤ Type 1 diabetes: From 1990 to 2021, the estimated annual change in type 1 diabetes was -3.15%;
➤ Type 2 diabetes: From 1990 to 2021, the estimated annual change in type 2 diabetes was -0.22%.
4. During the 30 years, "overall diabetes-related DALYs" showed an upward trend, while type 1 diabetes DALYs showed a downward trend
➤Overall diabetes: From 1990 to 2021, the annual change percentage of overall diabetes-related DALYs was 0.57%;
➤Type 1 diabetes: From 1990 to 2021, the estimated annual change percentage of type 1 diabetes-related DALYs was -2.29%;
➤Type 2 diabetes: From 1990 to 2021, the annual change percentage of type 2 diabetes-related DALYs was 0.69%.
Key populations: Men and the elderly face a greater burden of diabetes
Among male patients, both the value and ratio of diabetes-related DALYs increase with age, reaching a peak in the 65-69 age group. DALYs continued to rise in early adulthood and middle age, reaching their highest values in late adulthood, and slightly decreased in the oldest age group - specifically, DALYs values increased from 1316.32 in the <5-year-old group to 803249.83 in the 65-69-year-old group, and DALYs rates increased from 3.16/100,000 in the <5-year-old group to 4496.14/100,000 in the 90-94-year-old group.
In female patients, diabetes-related DALYs values and rates increased with age, but there were some fluctuations in older age groups - DALYs peaked in the 65-69-year-old group and then decreased slightly. DALYs values increased from 1870.69 in the <5-year-old group to 839864.06 in the 65-69-year-old group. DALYs rates increased from 5.19/100,000 in the <5-year-old group to 2770.69/100,000 in the 75-79-year-old group.
Overall, male patients with diabetes had higher DALYs than female patients in all age groups. DALYs for both sexes increased with age, with the highest burden observed in late adulthood, indicating that diabetes has a greater impact on the elderly.
Risk factors Multiple risk factors contribute to the increased burden of diabetes
Studies have shown that various risk factors (such as air pollution, smoking, drinking, poor eating habits, lack of exercise, overweight/obesity, and high fasting blood glucose) have a significant impact on the disability-adjusted life years of Chinese patients with diabetes, affecting all age groups and genders.
For diabetic patients aged 40-95 years, the top two risk factors leading to increased DALYs are high fasting blood glucose and high BMI. From 40 to 79 years old, the third risk factor is dietary risk, while after 79 years old, the third risk factor is air pollution. For T1DM, the biggest risk factor is still high fasting blood glucose, followed by non-optimal temperature.
Discussion and suggestions
The research data show that from 1990 to 2021, the age-standardized incidence, prevalence, and DALYs rates of overall diabetes, type 1 diabetes, and type 2 diabetes in China showed an overall increasing trend. The results are consistent with previous studies and can be attributed to improved economic and social development, chronic diseases such as hypertension and hyperlipidemia, longer survival, and unhealthy lifestyles, including smoking, drinking, and sedentary behavior. In addition, China's aging population is an important driver of the increase in diabetes incidence and prevalence.
The age-standardized mortality rate for diabetes is on a downward trend, indicating a lower risk of diabetes-related death in China, which may be related to increased access to health services and advances in medical care in recent years. Diabetes has a high prevalence and disability rate, leading to serious complications that affect the heart, blood vessels, eyes, kidneys, and nerves. The cost of treatment for patients with complications is significantly higher than that for patients without complications. Despite this, studies have shown that the awareness rate of diabetes in China is only 36.5%, the treatment rate is 32.2%, and the control rate of treated people is 49.2%. Therefore, it is crucial to raise public awareness of self-management of blood sugar levels, emphasize early diagnosis of diabetes, improve the quality of diabetes management in the community, reduce the incidence of diabetes complications, and reduce the disability burden caused by diabetes.
Type 2 diabetes is the main burden of diabetes in China, which mainly occurs in adulthood, and obesity is an important risk factor. Studies have shown that regular moderate-intensity exercise can effectively prevent the occurrence of the disease. In addition, participating in physical activities can affect the body's blood sugar levels and reduce the risk of developing diabetes.
From a gender perspective, Chinese men showed higher DALYs than women in most age groups between 1990 and 2021. This difference may be due to the higher levels of male exposure to risk factors such as obesity, smoking, excessive drinking and sedentary behavior; from the perspective of age distribution, the high incidence of DALYs caused by overall diabetes and type 2 diabetes in China in 2021 was between 50 and 74 years old. The values and rates of DALYs continue to increase with age, reaching a peak in the 65-69 age group, indicating that diabetes has a greater impact on the elderly. For type 1 diabetes, the DALYs peak occurs in middle age, especially in adults aged 40-44. The results of the study suggest that health monitoring of the middle-aged and elderly population should be strengthened, with special attention paid to improving the health awareness of middle-aged and elderly men, and encouraging regular blood sugar checks in this population.
Analysis of diabetes risk factors showed that multiple risk factors had a significant impact on diabetes DALYs in my country. The main risk factors included high fasting blood glucose, high BMI, dietary risk, air pollution, tobacco, low physical activity, inappropriate temperature and drinking.
Among them, diabetes-related DALYs caused by high fasting blood glucose have always remained at a high level. DALYs caused by dietary risk, drinking and high BMI are on the rise, while DALYs caused by air pollution, tobacco, low physical activity and inappropriate temperature are on the decline.
Summary of this article
Overall, the incidence, prevalence and DALYs rate of diabetes in my country are at a high level, and the disability burden is serious and the growth rate is rapid, especially in the male group. To this end, the study recommends strengthening intervention measures for major diabetes risk factors, including high fasting blood glucose, high BMI, air pollution and unhealthy eating habits. Effective treatment and management of diabetic patients is of great significance to reducing the mortality caused by diabetes and improving the quality of life of patients. In the face of the increasing burden of diabetes, it is particularly important to prepare for long-term management.
How Does Cistanche Treat Kidney Disease?
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