Diabetes in China - Coursework Example

DIABETES IN CHINA Diabetes is a rapidly spreading disease all over the world. More than 100 million people suffer from this disease globally. Almosthalf of them live in China. It has been reported by China National News that about 45 million populations with diabetes lives in China and it increase at the rate of 1 million annually. Almost 95% of total Chinese diabetes patients suffer from Type 2 whereas less than 5% are Type 1 diabetes. The study focused on China for various reasons some of them are: Adequate data was not available in because of lack of studies about incidence of diabetes in Asian countries particularly China. Because of large of population of China and also because of diets and patterns of infectious diseases, China is ideal country to conduct etiology study here. Some studies indicated an economic standard correlation to the incidence rate of diabetes. The incidence rate in China is 3.21% in 1996 quite higher in developing countries, it significantly increased in the following years. Diabetes study of Singapore is quite revealing. In 1975 the incidence rate of diabetes in Singapore was 1.19%; it gradually increased and reached to 4%, in 1992. In 17 years, the incidence rate of diabetes in Singapore increased to 8 times. The case studies from Singapore and Korea clearly indicate that if the rapid economic and social development of countries is directly related to rate of incidence of diabetes. The more country develops, the higher prevalence of diabetes occurs. In the same way, China is rapidly growing during the past two decades. This rapid growth has resulted in increase in the rate of modernization and urbanization. The incidence of prevalence of diabetes in Chinese adult increased three-fold from approximately 1% in 1980 to 3.2% in 1996. The incidence of diabetes is increasing equally with increase in economic growth of the country. With increase of prevalence of diabetes in Asian Countries China and India are major contributors because of their large populations and growing economies. China is the second largest prevalence of diabetes in the region as greater urbanization, industrialization, and lifestyle changes, because of economic prosperity and increasing rates of obesity. Growth in economy has resulted in change in the life style and eating habits of Chinese people. Availability of fast foods and a inactive lifestyle, along with lack of physical activities and play, increase in use of television and computers, and mechanization have rapidly changed the behavior patterns of the urbanized young in many of Asia's large cities. Similar situation is prevalent in China. The epidemiological transition can be observed in its most complete form in developed countries and at it is at its earliest stages in developing countries. RESULTS OF VARIOUS SURVEYS/STUDIES First systematic and organized survey was conducted in the late 1970s in China in Shanghai City. It was recorded that incidence of diabetes is 1.07% in 1979 but it was doubled in 1989. Available data shows that the prevalence of diabetes in Shanghai has reached to 2.123% in 1989 while Chengdu was 1.354% in 1992. But in 1982, Chengdu City demonstrated its prevalence of diabetes as 1.29%, which was the highest rate. Another diabetes survey of 14 major cities was conducted by nationwide cooperative group in 1980, it shows the average of prevalence of diabetes was 0.67%. A study conducted in 1993 shows that, the prevalence of diabetes was 2.5% in China but its mortality has become the third largest disease cause death in China after cancer and cardiovascular disease. In 1997, the 11 cities diabetes survey shows the average of prevalence of diabetes was 3.21% that is 3 times double the rate in 1979. A study was carried out in 1996, under the WHO criteria and epidemiology method, a updated 11 major cities survey shows that the prevalence of diabetes was 3.21% in China, which increased almost 5 times compared to the first survey in 1980. It is estimated that the prevalence of diabetes in China will increase by 69% between 1996 and 2025. The WHO report of 1995, shows the prevalence of diabetes was 2.0% in China and the number of people with diabetes was 16,016,000 but in 2000 the number has already reached to 20,757,000 and the future estimated number in 2030 will be 42,321,000. The number of people with diabetes positions China as the second largest diabetic's population in the world. The increase is 104% while about 115% of change primarily occurs in urban population. The incidence among those age (15-74) years has increased from 0.67% in the early 1980s to 3.21% in the mid 1990s and 6-7% in 2001-2002. The report of Shandong shows the prevalence of diabetes (age 18) is 5.42%, which is higher than the diabetes survey of 11 cities conducted in 1997. Diabetes patients (age 40) are surprisingly more than others. The report of Shandong study reveals the risk factor to diabetes as family history, more salty food, smoking, drinking, less physics activity, exceeds BMI and WHR. The prevalence of each indication has shown in the table below. In 1998, a survey of diabetes prevalence of Shanghai shows the prevalence rates of diabetes and IGT has been significantly increasing in urbanite adults of Shanghai in recent years. Amount of 9376 urbanite adults, there are 299 people found to be diabetes. The prevalence rate is 3.19%. The increase is 300% compared to 1.01% from the first survey in 1979, compared to 2.51% in 1994. In 2002, a study on the prevalence of diabetes in urban and rural Chinese population in Qingdao reported higher prevalence of diabetes in the urban versus rural. The higher prevalence of diabetes in the older age groups of Chinese population may raise concern in aging population, as this will add greater burden to the healthcare cost. On the other hand, the prevalence rates of diabetes of the younger age groups (i.e.20-25 and 30-39) are relatively low, but the IGT, diabetes ratios are high in these groups (Fig 2). There is higher risk for individuals with impaired glucose. In 1994, national diabetes collaboration association conducted a report shows the income of individual can be considered as an indirect factor to suffer diabetes. It has again proved the finding previously found in western medical research. According to the research, the difference of individual's income may produce diversity in people's diet, physical activities or living standard while these outcomes are proven to be the risk factors to diabetes disease. The study shows the correlation between smoking, drinking and diabetes. They may reduce the exercise, blood glucose. In 2002, the Chinese nutrition and state of health investigation department reveals that, the prevalence rate of diabetes in age group of ( 18) resident is 2.6%. The prevalence of diabetes observably is higher in urban than in rural compared to 1996 as the prevalence of diabetes was 4.6% rose to 6.4% in age group of ( 20), and in small city rose from 3.4% to 3.9%; A review conducted from 1996 to 2005 (accumulation to May) on 920 diabetes in-patients in Shenyang city hospital, reveals the number of diabetes in-patients was 244 until 2001, but from 2001 to 2005 the number of diabetes in-patients was increased to 676. The head of hospital Dr. Chang Jia Yi claims it was due to the social progress and the economical fast development. The incidence of diabetes is getting higher as more young adults are suffering earlier. DIFFERENCE IN PREVELANCE IN URBAN AND RURAL AREAS Anhui city hospital in China shows the mortality of diabetes was 64% higher in rural (82.0%) than urban (18.0%) during 1984 to 1993. But during 1994 to 2003, the mortality in urban was increased to 30% while rural remained at 70%. The death of cardiovascular disease associated with diabetes in urban was also increased to 35.9% from 17.1% during 1994 to 2003. During 2001-2002, the prevalence of type 2 diabetes in urban and rural of Qingdao city reveals: Men had a higher prevalence of diabetes than women, whereas the prevalence of undiagnosed diabetes was lower in men than in women. Diabetes was more prevalent in the urban than in the rural population 6.9% vs. 5.6%. The proportion of undiagnosed diabetes was higher in the rural than in the urban areas (70.5% vs. 58.0%) The conclusion of type 2 diabetes in Qingdao city is moderately high, but much higher than reported in 1996. The large proportion of undiagnosed cases of diabetes indicates the lack of public awareness of diabetes and shortage of medical facilities. China likes other Asian countries, a higher prevalence of diabetes among urban than among rural populations has been evident in a number of lifestyle factors such as physical inactivity, unhealthy diets, and obesity, which are implicated in the aetiology of diabetes. Urban residents were significantly more obese, physically less active and had a higher prevalence of parental history of diabetes than did rural subjects. In China, rural residents eat more grain and less animal meat, have less education, but practise more vigorous physical activity than urban residents. The prevalence of diabetes, both previously undiagnosed and known, was lowest in the youngest aged 20-30 group, with a sharp increase at 30-40 years of age. Thereafter, the prevalence of diabetes continued to increase up to the oldest age group 70-74. In summary, the study reveals that the prevalence of diabetes in the urban Chinese population of Qingdao is as high as that seen in Hong Kong and Taiwan in the mid 1990s, and the urban population of Qingdao has a higher prevalence of diabetes than does the rural population. The high proportion of previously undiagnosed diabetes, especially in rural areas, indicates the lack of public awareness of the disease and the lack of a case-finding strategy for asymptomomatic diabetes by medical facilities. The proportion of undiagnosed diabetes cases was significantly higher in rural than in urban areas, indicating a shortage of medical facilities and poor public awareness of the disease among rural residents. PREVELANCE OF DIABETES IN HONG KONG AND TAIWAN In 2005, Hong Kong Chief Executive of HA (Hospital Authority) Dr. William Ho believed the diabetes has become one of epidemic disease in the world as more young adult are found to be diabetic patients. In Hong Kong, one-tenth people are found as diabetes while in aged 65 one-fifth people is found as diabetes. In Taiwan, diabetes ranks among the top 10 leading causes of death for men and women and affects over 900,000 People in the Island. The number of new cases is increasing by 110,000 annually. Diabetes accounts one fourth in-patient; furthermore, Type 2 diabetes patients accounts 1 in every 16 outpatient (1/4 for diabetes care and for the care of diabetic complication.). This study provides consolidated information about the overall trends of prevalence of diabetes and IGT, and significance of undiagnosed diabetes of the Chinese populations in Mainland China, Hong Kong, and Taiwan. It firstly reviews population in Hong Kong and Taiwan have significant higher prevalence rates of diabetes than mainland China. A large proportion 68.6% of diabetic patients remains undiagnosed in Mainland China as compared to 52.6% in Hong Kong and Taiwan. The prevalence rates of diabetes and IGT of the Chinese populations rise in older age group. With economic development and change lifestyle as physical inactivity and rich in high-fat diet, prevalence of diabetes of the Chinese populations is clearly on the rise. Hong Kong experience change in environment and lifestyle which can affect the development of diabetes. The prevalence of diabetes of Chinese populations in Hong Kong and Taiwan may reflect the future upward trend in Mainland China. In the period of 1985 - 1994, Mainland Chinese's prevalence rates of diabetes were consistently lower than their counterparts in Hong Kong and Taiwan in the same age groups. In the period, 1995 -2003, the prevalence of diabetes in some studies in Mainland China remained low, but some studies were par with or even higher than some of their counterpart in Hong Kong and Taiwan. Chinese people in Hong Kong and Taiwan are generally living in an urbanized environment. Physical inactivity, diets high in fact and sodium and low in fruit and vegetables and increase work-related stress are a few of the lifestyle factors associated with urbanization. In Hong Kong, regarding to 2 large-scale population-based studies, the prevalence of overweight (BMI 25 kgm2) increased from 28% to 38% in men and from 28% to 34% in women during 1990 to 1995, respectively. A prospective 2 years study on obese of Hong Kong Chinese found that the obese people had significantly rates of progression to diabetes. In Taiwan, a population-based nutritional survey revealed that 24.5 % of the male and 25.2% of the female adults in Taiwan were obese; A 2002-2003 cross-sectional study in Taiwan reported a significant upward trend of BMI of Taiwanese people, which indicates the obese Taiwanese are at increased risk of developing diabetes. Within Mainland China, there is an upward trend in the prevalence of diabetes when the prevalence rates are compared between the time (1985-1994 and 1995 -2003) for the same age groups. This upward trend can be addressed from aspects such as urbanization, change of diagnostic criteria, change of lifestyle, (such as diet and physical activity) within Mainland China. This information is useful for public health planning and health promotion such as diabetes screening, management and education. Chinese people in Mainland China are currently experiencing an upward trend in the prevalence of diabetes. They have not reached the level of Chinese people living in developed regions. With economic advancement, change toward urbanized lifestyle (i.e. lack of physical activity and increase caloric intake), and the consequent increase in obesity; there will be potential increase in the prevalence of diabetes in the Chinese population. The high proportions of diabetic patients are undiagnosed should raise the awareness for intervention to curb the undesirable upward trend. If there are no early diagnosis and intervention strategies for diabetes and IGT, tremendous increase in burdens caused by diabetes will ensue. The Chinese IDDM registry was established in 1991 as part of the WHO DiaMond Project. There are 22 centres in this registry, which cover 0.4 million km2. In total, according to the 1990 Chinese census data, 20,654,990 children less than 15 years of age were monitored, which represents - 7% of the children in China. The study proves China has an extremely low overall IDDM incidence rate. China also have the greatest geographic and ethic variation seen for any countries. Read More