Prevalence and Treatment of Diabetes in China, 2013-2018

Importance: Recent data on prevalence, awareness, treatment, and risk factors of diabetes in China is necessary for interventional efforts. Objective: To estimate trends in prevalence, awareness, treatment, and risk factors of diabetes in China based on national data. Design, Setting, and Participants: Cross-sectional nationally representative survey data collected in adults aged 18 years or older in mainland China from 170 287 participants in the 2013-2014 years and 173 642 participants in the 2018-2019 years. Exposures: Fasting plasma glucose and hemoglobin A1c 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 diabetes and prediabetes defined according to American Diabetes Association criteria. Secondary outcomes were awareness, treatment, and control of diabetes and prevalence of risk factors. A hemoglobin A1c level of less than 7.0% (53 mmol/mol) among treated patients with diabetes was considered adequate glycemic control. Results: In 2013, the median age was 55.8 years (IQR, 46.4-65.2 years) and the weighted proportion of women was 50.0%; in 2018, the median age was 51.3 years (IQR, 42.1-61.6 years), and the weighted proportion of women was 49.5%. The estimated prevalence of diabetes increased from 10.9% (95% CI, 10.4%-11.5%) in 2013 to 12.4% (95% CI, 11.8%-13.0%) in 2018 (P < .001). The estimated prevalence of prediabetes was 35.7% (95% CI, 34.2%-37.3%) in 2013 and 38.1% (95% CI, 36.4%-39.7%) in 2018 (P = .07). In 2018, among adults with diabetes, 36.7% (95% CI, 34.7%-38.6%) reported being aware of their condition, and 32.9% (95% CI, 30.9%-34.8%) reported being treated; 50.1% (95% CI, 47.5%-52.6%) of patients receiving treatment were controlled adequately. These rates did not change significantly from 2013. From 2013 to 2018, low physical activity, high intake of red meat, overweight, and obesity significantly increased in prevalence. Conclusions and Relevance: In this survey study, the estimated diabetes prevalence was high and increased from 2013 to 2018. There was no significant improvement in the estimated prevalence of adequate treatment.