Diabetes Epidemic Looms in China
Vicky Ge Huang
In a small private hotel in Beijing, Baoming Li cautiously took out his insulin-filled syringe. Holding the syringe upright, he pushed the plunger down until all the insulin was gone. It was only part of Li’s daily regime as a Type One diabetes patient. In the eyes of the hotel owner who happened to walk past, though, it looked like someone abusing drugs right in the lobby of his hotel.
Li, 52, who works at an auto repair shop in the western suburbs of Beijing, has had Type One diabetes, also known as childhood diabetes, since he was diagnosed at the age of nine. After years of shying away from treating himself in public, because of the suspicious looks of passersby, Li has become more assertive and now injects himself with insulin when needed, regardless of the location.
“The hotel owner gave me 20% off out of fear that I would do something to him as a drug abuser,” remembered Li with a chuckle. “I used to hide myself to take insulin injections. But later on I feel like I’m not doing anything wrong, so why should I hide myself? I decided to just do my thing and let others talk.”
As a Type One diabetes patient, Li’s case represents 5% of all diabetes patients in China where 114 million people are diabetic — about a third of all of the people with the disease worldwide, according to the International Diabetes Federation. At an increasingly alarming rate, Type Two diabetes, mostly caused by unhealthy lifestyles and obesity, is also posing a huge social, economic and medical threat to the Chinese population. Domestic and international experts are calling it a diabetes epidemic in China, yet the stigma and lack of public awareness associated with the disease persists in Chinese society. Because of China’s 1.4 billion population, the greater concern is the government’s lack of a comprehensive system in preparing primary care for patients with chronic diseases such as the diabetes.
“The Chinese government is doing everything it can to deal with the epidemic of chronic diseases such as diabetes,” said Guang Ning, vice-chairman of the Chinese Endocrine Society and head of the Shanghai Clinical Center for Endocrine and Metabolic Disease. “Population-wide strategies to promote healthy behaviors are of vital importance to retard the progression of diabetes epidemic and to prevent related micro- and macro-vascular complications.”
The diabetes epidemic didn’t just arrive overnight. It came from China’s rapid economic development during the past two decades, which has led to urbanization, an increase in sedentary lifestyles, increased consumption of sugary and high-calorie diets, excessive smoking and the lack of exercise.
“For a long time, Chinese people were living with a lifestyle characterized by strenuous physical activity and a low-calorie, carbohydrate-rich diet with little animal fat,” said Yuying Zhang, doctor at the Translational Centre of the First Affiliated Hospital of Sun Yet-Sen University in Guangzhou, China. “The so called ‘starve genes’ make people survive in the extreme hardship. However, when their lives improve, these genes lead to a relative overload in sugars and a higher risk of developing diabetes.”
Fuxing Liang, a 50-year-old civil servant in Baoji, Shaanxi Province who served in the military from 1986 to 2000 in the Xinjiang Uygur Autonomous Region, believes that it was his limitless lifestyle after leaving the regimented military that has led to his diagnosis of Type Two diabetes. “I drank without reservations, usually between 400 grams to 500 grams of Chinese white wine each time I had the opportunity to drink. I also consumed lots of meat. I especially loved to eat watermelons during the summer, sometimes eating two in a row,” added Liang with a sigh. “I never exercised. I would just go lie down in my bed immediately after finishing a meal and I took a nap after lunch every day.”
Liang is one of the millions of Chinese people who are suffering from what are known as diseases of affluence that demand long-term treatment, Type Two diabetes being one of the most common ones in this category. The potential of a public health catastrophe due to the onslaught of diabetes is further highlighted by data published recently by the The Journal of the American Medical Association, which suggests that China has overtaken the U.S. in terms of diabetes prevalence.
Before a person develops Type Two 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. The same journal article estimates that 493 million people — or one in two adults — in China has pre-diabetes. Without treatment, those with pre-diabetes will develop full-fledged diabetes in 10 years or less.
Faced with the possibility of an overwhelmed health care system for diabetics, Linlin Wu, who works with Bernhard Schwartländer, a World Health Organization representative in China, said that the Chinese government is paying increasing attention to the importance of addressing rising rates of diseases like diabetes. But there is certainly more to do, “both in prevention, as well as in improving treatment and management of the condition for the millions of people who already have it: more than half of people with diabetes in China may be undiagnosed.”
Indeed, Novo Nordisk, a Danish multinational pharmaceutical company that has been in China for 22 years disclosed during an interview about their rising insulin sales in China: “The biggest challenge remains to be low awareness about diabetes among general public and even physicians in some rural areas.”
Even within China, there is still a huge difference in health care between urban and rural areas. Urban citizens have far better health insurance coverage from the government and employers while enjoying a far more developed health care system than those in the rural areas. On a global scale, diabetes rates are increasing fast in low and middle-income countries such as China and India. A study published in The Lancet, an independent general medical journal, suggests that half of adults worldwide with diabetes in 2014 lived in the following five countries: China, India, USA, Brazil and Indonesia.
Juliana Chan, director at the Hong Kong Institute of Diabetes and Obesity, said, “Diabetes is a social phenomenon that has turned into a medical problem. Diabetes is a product of modernization.”