A large study of over 500,000 adults in China revealed that diabetic adults lose an average of nine years of life. A total of 3.64 million person-years of follow up was analysed, with patient data collected between 2004 to 2008, and observed until 2014.

Particularly disconcerting findings were that a high proportion of patients had died due to diabetic ketoacidosis and chronic kidney disease. “This is indicative of poor clinical management,” comments Dr Margaret Chan, MD of the World Health Organisation (WHO) at the time.

Causes of death in diabetic patients in China different from Western countries

The study highlights that the diabetic population in the West were more likely to succumb to ischaemic heart disease rather than stroke. Based on this data, the reverse was seen in China.

Furthermore, 16% of rural patients were reported to have died due to diabetic ketoacidosis despite being on diabetic medication. From previous reports in the United States, only an estimated 1% was recorded to have died due to those causes.

“The problem is that most patients are not very well managed. That’s why we see a very substantial risk of death for a wide range of disease, including cardiovascular disease,” says Dr Zhengming Chen, of the Nuffield Department of Population Health in Oxford, UK and lead author of the study.

Rural population in China were found to suffer higher mortality rates

This study managed to capture the difference in mortality rates between urban and rural diabetic populations. The rural population had a significantly higher risk of dying (risk ration of 2.17 vs. 1.85) compared to the urban population.

“This reflects largely the failure of the delivery of healthcare for diabetes… it is important evidence to highlight the gap that needs to be focused on in the future,” says Dr Chen.

Where a person lives has long known to have an impact on health. This data mirrors a previous study examining the healthcare gap between urban and rural areas in China that found that the rural population experienced 30% higher standardised mortality rates.

10% of adults in China live with diabetes

Diabetes is a massive issue in China. “Rates of type 2 diabetes in China have exploded in the last couple of decades. In 1980, less than 5% of Chinese men had diabetes. Now, more than 10% (110 million people) do” says the WHO representative of China, Dr Bernhard Schwartländer.

He attributes this skyrocketing due to sedentary lifestyles and diets rich in fat and sugar. Even more worrying is the fact that 500 million adults in China have been deemed prediabetic.

One million deaths in China occur each year as a result of diabetic complications – with 40% of those who died are under the age of 70.

A survey in 2010 estimates that only 25% of patients with diabetes are receiving the necessary treatment. Diabetes accounts for 13% of China’s medical expenditures, and up to RMB 173.4 billion (US $25 billion) is spent a year on diabetes management.

In Hong Kong, diabetes is the 10th most common cause of death. Asian countries contribute to 60% of the world’s diabetic population. A combination of genetic predisposition and lower tolerance for environmental risk factors have resulted in Asians developing diabetes at much s lower body mass index when compared to Western countries. As such, the healthcare sector should strive to strengthen preventive programs and work towards excellent management practices to fend off the growing epidemic. MIMS

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