The incidence of diabetes has risen sharply in China from 1% in 1980 to 12.8% in 2017, and it is expected to continue to rise, despite the disease being one of four targeted by the Chinese government in its Healthy China Action Plan 2019-2030. Diabetes takes a high toll, both economically and in terms of healthy years of life. The disease is a major cause of strokes, heart attacks, blindness, and lower limb amputations. Although diabetes is on the rise, treatment and control remain relatively low in China, especially in rural areas.

In a new paper in The Lancet Regional Health—Western Pacific, a research team, which included APARC's Asia Health Policy Program Director Karen Eggleston, examined how improved control of glycemia and blood pressure, two modifiable risk factors for diabetes, could improve health outcomes in China. They performed a microsimulation analysis of more than 20,000 Chinese adults with diabetes, with data taken from the China Chronic Disease and Nutrition Surveillance survey (CCDNS), looking at the increased control of glycemia and blood pressure in 31 different scenarios.

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Similar studies had previously relied upon simulated risk factor levels that did not accurately reflect a representative Chinese population or used non-Asian models that have been known to over-predict medical complications in Chinese populations. The CCDNS data the authors used in their study was collected in 2018-19 from national disease surveillance points in mainland China, and their microsimulation used the CHIME (Chinese Hong Kong Integrated Modelling and Evaluation) model, which has been validated in East Asian populations.

Based on the CCDNS data, only one in five (20.1%) of people with diabetes in China had achieved optimal control of both glycemia and blood pressure in 2018-19. The study modeled control rates of 70%, 80%, and 100% to see the effects on the population’s health. The authors found that control of the two risk factors in people with type 2 diabetes was associated with considerable improvement in health, a reduced number of early deaths, and savings in medical costs. For example, if China were to achieve 70% control of these risk factors (based on current WHO/Chinese Diabetes Society targets for blood glucose and blood pressure), deaths before age 70 could be cut by 7.1% and medical costs by 14.9% over the next 10 years.

The study provides more impetus for China to reach its control targets outlined in the Healthy China plan, which aims for the nation to reach by 2030 health indicator performance comparable to high-income countries like the United States. The authors demonstrate that the health and economic burdens associated with diabetes can be substantially reduced or avoided if glycemia and blood pressure are better regulated in the Chinese population.