China's economic growth in the last three decades has dramatically transformed the nation's economic landscape, removing 500 million people from poverty. This progress, however, has been accompanied by an increase in some diseases – such as diabetes – notably associated with increased urbanisation and changed lifestyles. Twenty-five years ago, the number of people with diabetes in China was less than 1%. Today, China has more than 114 million people suffering from the disease, the highest number of any country in the world. It is estimated that 11.6% of Chinese adults have diabetes, a proportion higher than the US with 11.3%. Experts blame the increase in sedentary lifestyles, high consumption of sugary and high-calorie Western diets, excessive smoking and lack of exercise. According to some experts, India and China will have an increase of an additional 48.5 million people with diabetes between 2007 and 2025. Because the number of people suffering from this disease in China is increasing rapidly, the cost of treating diabetes and its complications can reach extremely high levels, and have a significant impact in the country's economy. According to the International Diabetes Federation, 13% of medical expenditures in China are directly caused by diabetes. The yearly costs are $25bn. It is estimated that these costs will increase substantially, and reach more than $47bn in 2030. In China, lost productivity costs alone are equivalent to 0.6% of GDP as reported by The Economist Intelligence Unit in 2007. Both types of diabetes exact three kinds of economic costs: direct, indirect and those resulting from lost productivity. The direct costs include medical visits and treatment, medications and hospitalisation for the disease and its complications. Indirect costs, which include informal care by relatives and paramedical personnel, constitute almost half the total cost of diabetes. Loss of productivity costs include those due to the consequences of the disability caused by the disease and its complications. Diabetes also places a heavy toll on household income. People with diabetes spend nine times more money in healthcare than healthy people of the same age and sex without diabetes. Those who have had diabetes for more than 10 years spent an estimated 22% of their household income for health care. The total estimated cost of diabetes in the US was $245bn in 2012, of which 43% was for hospital inpatient care, 18% for prescription medications to treat the complications of the disease, and 12% was for anti-diabetic agents. People with diabetes report 3-4 times more in-patient care, out-patient visits and emergency room visits than people without diabetes of the same age and sex. In addition, health expenditures for people who have had diabetes for 10 or more years are 460% higher than for people who have had diabetes for 1-2 years. Of the two kinds of diabetes, Type 1, is diagnosed primarily in children and young adults, and has probably genetic and environmental components. Type 2 diabetes, which probably also has a small genetic component, is mostly caused by unhealthy lifestyles and obesity. Type 1 diabetes accounts for approximately 5% of all cases. Before a person develops Type 2 diabetes, they frequently have a condition called pre-diabetes, which has no symptoms. In pre-diabetes, blood glucose levels are higher than normal but not high enough to qualify people as diabetics. It is estimated that 493 million people – or one in two adults – in China have pre-diabetes. Without treatment, those with pre-diabetes will develop full-fledged diabetes in 10 years or less. What makes this condition particularly serious is that it is frequently ignored, and those affected by it are at a 50% higher risk of heart disease and stroke than those who don't have pre-diabetes. According to some estimates, each year 6%-7% of those with pre-diabetes will be added to the diabetes population. In Type 1 diabetes the body doesn't produce enough, or in many cases any, insulin, while in Type 2 diabetes the body still produces insulin but has lost the capacity to make use of the insulin it makes. Because of increasing rates of obesity, children are now more affected by this last type of disease. In Japan, for example, Type 2 diabetes is now more common among Japanese children than Type 1 diabetes, and in China Type 2 diabetes is now being seen at younger ages. Increased awareness and education about the disease's damaging effects is critical. In October 2012, the Chinese government launched a three-year project called China National Plan for Non-Communicable Disease Prevention and Treatment (2012-2015) to train 100,000 community-level doctors in diabetes prevention and treatment. To improve the results of this plan, however, teachers in primary schools must also be trained and special classes should be devoted to this problem. Awareness should be raised in the general population about the importance of addressing risk factors, such as having poor eating habits, smoking in excess and having unhealthy lifestyles. If this serious crisis is not properly faced, it can provoke a most damaging effect on the country's economy and on the health status of the population. Cesar Chelala, MD, PhD, is an international public health consultant who has conducted health-related missions in over 50 countries worldwide. He is also a winner of an Overseas Press Club of America award.
