Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013

IMPORTANCE Previous studies have shown increasing prevalence of diabetes in China, which now has the world's largest diabetes epidemic. OBJECTIVES To estimate the recent prevalence and to investigate the ethnic variation of diabetes and prediabetes in the Chinese adult population. DESIGN, SETTING, AND PARTICIPANTS A nationally representative cross-sectional survey in 2013 in mainland China, which consisted of 170 287 participants. EXPOSURES Fasting plasma glucose and hemoglobin A(1c) levels were measured for all participants. A 2-hour oral glucose tolerance test was conducted for all participants without diagnosed diabetes. MAIN OUTCOMES AND MEASURES Primary outcomes were total diabetes and prediabetes defined according to the 2010 American Diabetes Association criteria. Awareness and treatment were also evaluated. Hemoglobin A(1c) concentration of less than 7.0% among treated diabetes patients was considered adequate glycemic control. Minority ethnic groups in China with at least 1000 participants (Tibetan, Zhuang, Manchu, Uyghur, and Muslim) were compared with Han participants. RESULTS Among the Chinese adult population, the estimated standardized prevalence of total diagnosed and undiagnosed diabetes was 10.9%(95% CI, 10.4%-11.5%); that of diagnosed diabetes, 4.0% (95% CI, 3.6%-4.3%); and that of prediabetes, 35.7%(95% CI, 34.1%-37.4%). Among persons with diabetes, 36.5%(95% CI, 34.3%-38.6%) were aware of their diagnosis and 32.2%(95% CI, 30.1%-34.2%) were treated; 49.2%(95% CI, 46.9%-51.5%) of patients treated had adequate glycemic control. Tibetan and Muslim Chinese had significantly lower crude prevalence of diabetes than Han participants (14.7% [95% CI, 14.6%-14.9%] for Han, 4.3%[95% CI, 3.5%-5.0%] for Tibetan, and 10.6%[95% CI, 9.3%-11.9%] for Muslim; P<.001 for Tibetan and Muslim compared with Han). In the multivariable logistic models, the adjusted odds ratios compared with Han participants were 0.42 (95% CI, 0.35-0.50) for diabetes and 0.77 (95% CI, 0.71-0.84) for prediabetes for Tibetan Chinese and 0.73 (95% CI, 0.63-0.85) for diabetes and 0.78 (95% CI, 0.71-0.86) for prediabetes in Muslim Chinese. CONCLUSIONS AND RELEVANCE Among adults in China, the estimated overall prevalence of diabetes was 10.9%, and that for prediabetes was 35.7%. Differences from previous estimates for 2010 may be due to an alternate method of measuring hemoglobin A(1c).