Cesar Chelala
A physician and writer

China’s silent epidemic

Diabetes, which is reaching epidemic proportions in China, is having a serious effect on its people’s health and on the country’s economy. It is estimated that in China about 12 percent of the population has diabetes, accounting for almost a quarter of the cases worldwide. These figures indicate that China has edged ahead of India, and has become the country with the highest population with diabetes in the world.

There are two types of diabetes: Type 1 and type 2. In type 1, which starts in childhood, the body does not produce enough –or sometimes any- insulin because the immune system has destroyed the insulin-producing cells. Most cases of diabetes are from the so-called type 2 diabetes; this is a form of the disease that results from resistance to insulin, which is a situation where cells fail to use insulin properly. Sometimes, type 2 diabetes is combined with a lack of insulin.

The cause of type 1 diabetes is still unknown, although genetic, viral, and environmental factors could be important in the development of the disease. On the contrary, type 2 diabetes has also a genetic component but is closely associated with unhealthy lifestyle, particularly obesity. However, it is important to indicate that although obesity is a significant risk factor for this type of diabetes, not every fat person has type 2 diabetes and not every type 2 diabetic person is fat.

Type 2 diabetes now accounts for 90 percent to 95 percent of all cases diabetes cases among adults. Of particular significance is the finding that most cases of diabetes are undiagnosed and untreated. Unlike type 1 diabetes, most cases of type 2 diabetes can be prevented by having a healthy lifestyle and avoid becoming obese.

The diabetes epidemic is not only a serious public health problem, but can also have serious economic repercussions as well. A 2007 study estimated that the medical costs for diabetes and its complications was 18.2% of China’s total health expenditures. Globally, diabetes caused at least US $966 billion dollars in health expenditure – a 316% increase over the last 15 years.

Experts believe that China’s rapid economic development associated with increased urbanization, physical inactivity and unhealthful diet and obesity are important contributing factors in the development of diabetes. Until just over a decade ago, diabetes was relatively rare in China. However, in the last decade the problem has become much more frequent and has gone hand in hand with dramatic changes in lifestyle.

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

Obesity has been found to contribute approximately 55% to 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% lower rate of diabetes. When a normal weight was included, the rate was 89% lower.

The increased rate of childhood obesity between 1960 and 2000 is believed to have led to the increase of type 2 diabetes in children and adolescents. In China, a study carried out from 2014 to 2018 in 2.7 million community-dwelling adults from 35 to 75 years, found that over one in seven individuals meet criteria for overall obesity, and one in three for abdominal obesity.

In the U.S., type 2 diabetes affects approximately 8 percent of adults. That proportion is increased to 18.3% among Americans age 60 and older, according to statistics from the American Diabetes Association. The International Diabetes Federation (IDF,) reports that in 2021 there were 537 million adults (20-79 years) living with diabetes, a figure expected to rise to 643 million by 2030 and 783 million by 2045. Until now, the rate of increase of diabetes in China has been much faster 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 as well. To avoid further damage to people’s health, it is urgent to develop and institute national strategies for preventing, detecting, and treating diabetes in the general population. Education and prevention, however, stressing the serious health risks associated with diabetes, continue to be the best and less costly strategies for dealing with this serious threat to people’s health.

About the Author
César Chelala is a physician and writer born in Argentina and living in the U.S. He wrote for leading newspapers all over the world and for the main medical journals, among them The New York Times, The Washington Post, The Wall Street Journal, The Japan Times, The China Daily, The Moscow Times, The International Herald Tribune, Le Monde Diplomatique, Harvard International Review, The Journal of the American Medical Association, The Lancet, Annals of Internal Medicine, and The British Medical Journal. He is a co-winner of an Overseas Press Club of America award and two national journalism awards from Argentina.
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