1、1,The Rising Challenge of Diabetes in China,Chang Yu Pan Department of Endocrinology, Chinese PLA General Hospital Chinese PLA Endocrinology and Metabolism Centre and Key Laboratory Apr.11- 2008,2,Medical and Health Annual Encyclopaedia Britannica, 1999,3,3,Death from Diabetes 2.90 Million (5.2%of t
2、otal mortality) Worldwide: 1 of 20 death is from diabetes (About 8,700 death /day or 6 death/min) About 1 of 4 death is DM in Asia-Pacific RegionDeath from AIDS: 3.0 Million,What AIDS was in the last 20 years of the 20th century, diabetes is going to be in the first 20 years of this century,Roglic e
3、t al, 2005,The Rising Challenge of Diabetes,4,Lifestyle changes, Urbanization and Longevity in China,National Nutrition and Health Survey (1982 2002) Carbohydrate +10% , Meat +57% eggs +69% Total Carloria:2254cal./person/day,5,Prevalence of overweight / obesity in China (20-70 years),Overweight/ obe
4、sity (BMI 25 kg/m2) (WHO criteria),Data from National Nutrition Survey (1992), the Working Group on Obesity in China (2002),Age-standardized Prevalence (%),6,Prevalence of overweight/obesity in Chinese children & adolescents (2002),Data from 2002 National Nutrition and Health Survey,WGOC criteria,%,
5、7,Prevalence of overweight/obesity in Chinese children & adolescents (1985- 2000),Ji C et al, Chinese Journal of Epidemiology 2004,8,9,Global prevalence of diabetes *,In 2007, the five countries with the largest numbers of people with diabetes are: India, China, United States, Russia, Germany By 202
6、5, the largest increases in diabetes prevalence will occur in low- and middle-income countries Each year an additional 7 million people worldwide develop diabetes,* Diabetes Atlas, 3rd edition, International Diabetes Federation, 2006,10,Peoples Republic of China,Prediabetes 2003 33 million (4%) 2025
7、 54 million (5%),Diabetes 2003 23 million (3%) 2025 46 million (4%),Sicree, Shaw, Zimmet. Diabetes Atlas. IDF. www.idf.org.2006,The prevalence of DM is increasing rapidly,11,Growing prevalence of diabetes and prediabetes in China,National Diabetes Research Group. Chin J Int Med 20:678,1981 Pan XR, e
8、t al. Diabetes 20:1664, 1997; Gu D, et al. Diabetologia 46:1190, 2003,*Screening with FPG only,12,Prevalence of IGT in all age groups was higher than that of Diabetes,Prevalence of IGT and Diabetes in 11 provinces, China,Chin J Epidemiol. 1998;19(5):282-285.,13,Shanghai Diabetes Institute,Isolated f
9、asting DM: 0.6%,Isolated post-challenge diabetes: 2.4%,Combined DM:1.9%,Total prevalence of newly diagnosed DM:4.9%,Total prevalence of prediabetes: 11.7%,Isolated IGT 8.8%,Isolated IFG 1.7%,IFG + IGT 1.2%,75%,15%,10%,Jia WP et al.Dibetologia 2007,Isolated post-challenge DM and IGT Common in China,1
10、4,Newly diagnosed diabetes (OGTT),33%,3%,23%,24%,17%,36%,37%,27%,OGTT cohort (n=2,263),Whole population (n=3,513),2/3 of patients have hyperglycaemia,3/4 of patients have hyperglycaemia,Previously known diabetes,Newly diagnosed diabetes (FPG test),NGT,Prediabetes,Hu DY, Pan CY,Yu DM. Eur Heart J 200
11、6;27:25739.,China Heart Survey dysglycemia is common in patients with CAD,15,WP Jia, et al. Diabetologia, 2006(in press),Epidemiological characteristics DM and IGT in a Chinese adult population: the Shanghai Diabetes Studies (SHDS),Prevalence(%),Incidence(%),three-year cumulative incidence rates,inc
12、idence rates per year,1999-2001, n=5628,2002-2004, n=2709,16,Chinese individuals with IGT progress to type 2 diabetes faster than American individuals with IGT,Chinese IGT population is at high risk of DM,Pan XR, et al. Diabetes Care 1997;20:53744. Knowler WC, et al. NEJM 2002;346:393403.,17,Da Qing
13、 IGT intervention Study577 IGT519 Control4% IGT0.4% NGT,The appearance of ECG consistent with CHD,IGT and the risk of CVD,Diabetes Care 1993:16.150-156,18,IGT and Atherosclerosis - Study from PLA General Hospital in China,*,*,*,IGT,NGT,DM,IGT,IGT,NGT,NGT,DM,DM,N: 97(NGT), 51(IGT), 73(DM) Adjusted by
14、 age and sex * P0.05, P0.005, v.s. NGT,Jing WS, Pan CY, Lu JM, et al.Chin J Endocrinol 20(2):136-139,19,The cumulative rate of CVD,Coxs Proportional Harzard Model,Xu Xj, Pan CY Tian H.et al, Chin J Gerontol.2001.,0.97,0.98,0.99,1.00,1,2,3,4,Year,NGT,IGT,DM,The CVD Risk of IGT and Diabetes- Study fro
15、m PLA General Hospital in China,Cumulative rate,0,20,CODIC2 Control of Type 2 Diabetes in China,Biao X, Pan CY, Ji LN, et al. CODIC2, 2007, in press,N=1530,N=2054,N=524,21,Surveillance of Type 2 Diabetes in China,2001 hospitals distribution: Grade 3: 32(65%), Grade 2: 17(35%) 2006 hospitals distribu
16、tion: Grade 3: 43(72%), Grade 2: 16(27%), Grade 1: 1(2%),Patient Population,22,BMI,Anti-obesity Treatment: 2001 2003 20061.5% 1.0% 1.0%,BMI was analysed for patients 18 years only,24.6,24.3,24.0,23.7,10,15,20,25,30,1998,2001,2003,2006,BMI (kg/m2),Pan CY. Intern Journ Endocr. & Mtab. 2005, 25 (3): 17
17、4-178.,23,WAIST,90.8,87.2,80,85,90,95,100,105,Male,Female,Waist(cm),Mean Waist in 2006,% Waist 90cm (Male) 80cm(Female),2003,2006,Waist was analysed for patients 18 years only,Pan CY. Intern Journ Endocr. & Mtab. 2005, 25 (3): 174-178,24,MEAN HbA1c LEVELS,% HbA1c 6.5% 8% 26% 11% 23%,% HbA1c 7% 18% 4
18、1% 26% 41%,Local HbA1c (past 12 month): 57% (1998), 31% (2001), 55% (2003), 54%(2006),8.8,7.7,7.5,7.6,0,1,2,3,4,5,6,7,8,9,10,11,12,Mean HbA1c(%),Nine years change in diabetes managementDIABCARE Study Result (1998-2006),Pan CY. Intern Journ Endocr. & Mtab. 2005, 25 (3): 174-178,25,LIPID PROFILES,Targ
19、et TC: 1.1 mmol/L TG: 1.5 mmol/L,43% 41% 41% 41%,32% 31% 28% 34%,52% 60% 60% 61%,5.0,5.1,5.1,4.9,3.5,4.5,5.5,1998,2001,2003,2006,mmol/L,1.3,1.4,1.3,1.4,1.0,1.1,1.2,1.3,1.4,1.5,1998,2001,2003,2006,1.9,2.0,1.9,2.1,1.0,1.2,1.4,1.6,1.8,2.0,2.2,2.4,2.6,1998,2001,2003,2006,TC,HDL-c,TG,Pan CY. Intern Journ
20、 Endocr. & Mtab. 2005, 25 (3): 174-178,26,Type of Treatment for Dyslipidaemia,Pan CY. Intern Journ Endocr. & Mtab. 2005, 25 (3): 174-178,27,HYPERTENSION+,+ sbp/dbp 130/80 (recommendation on optimal control ofADA 2004 & AP guidelines 2002),Treatment for Hypertension 2001: 44% 2003: 48% 2006: 53%,1998
21、 2001 2003 2006 Smoking: 14% 18% 17% 21% Drinking: 14% 11% 11% 16%,Patient is currently a smoker or consumes alcohol (Regular consumption is defined as more than 3 times per week),76.1,77.2,0,10,20,30,40,50,60,70,80,2003,2006,Proportion of Patients (%),response rate 98% 99%,Pan CY. Intern Journ Endo
22、cr. & Mtab. 2005, 25 (3): 174-178,28,METABOLIC SYNDROME,CDS- Chinese Diabetes Society IDF- International Diabetes Federation,29,About 55% DM outpatients have complications,Biao X, Pan CY, Ji LN, et al. CODIC2, 2007, in press,Top three complications,Complication of Type 2 Diabetes in China,30,Global
23、cost of diabetes*,Economic and societal costs mainly arise from complications of diabetes Economic consequences result largely from: Cost of care Loss of productivity due to disability and premature death In 2007, global health expenditures to treat and prevent diabetes total at least US $232 billio
24、n,* Diabetes Atlas, 3rd edition, International Diabetes Federation, 2006,31,Total Direct Medical Cost of treating Type 2 DM in urban China,Billion RMB,4.38%,Chen Xingbao.Chinese health economics,2003* Tang Ling. China Diabetic Journal.2003*,32,Direct Medical Cost for patients with Diabetes in China,
25、Billion RMB,18.9%,81.1%,0.00%,50.00%,100.00%,Direct Medical Cost,Direct Medical Cost for patients with complication),(Direct Medical Cost for patients without complications),Chen Xingbao.Chinese health economics,2003* Tang Ling. China Diabetic Journal.2003*,33,Effect of complications on costs,Increa
26、se in costs vs. no complications,218%,313%,935%,Chen Xingbao.Chinese health economics,2003* Tang Ling. China Diabetic Journal.2003*,Total Direct Medical Cost of treating Type 2 DM in urban China,RMB,34,CHD deaths than expected from baseline mortality rates,Data from England and Wales between 1981 an
27、d 2000 in men and women aged 3584 years There were 68,230 fewer CHD deaths than expected from baseline mortality rates in 1981,-100,000,-80,000,-60,000,-40,000,-20,000,0,20,000,Deaths prevented or postponed in 2000,Factors CHD deaths include smoking, cholesterol, and BP and changes in treatments,Fac
28、tors CHD deaths include diabetes and obesity,Unal B, et al. Circulation 2004; 109:11011107.,延迟或预防死亡, 68,230,( 2,0003,000),35,Diabetes mortality continues its steady escalation,Freid VM, et al. National Center for Health Statistics, 2003.,36,Cause of death in China,Data from National Disease Surveill
29、ance System of China (1991-2000),Top 3 fatal diseases in 2000,1,412,999,2,488,266,1,530,423,Cause of death in China,37,Motality of Diabetes in Urban Chinese,Sources: Ministry of Health of China: Annual Statistical Reports of Death, injuries and Cause of Death 2001,38,WPDD 2002. www.wpdd.org/download
30、s/Diabetes_Book.pdf.,Early Diagnosis of Prediabetes is essential,Western Pacific Diabetes Declaration (WPDD) Guidelines:“The risk of Complications is Related to the Duration of Diabetes, as well as the Degree of Hyperglycaemia. However, due to Delayed Diagnosis, these Complications may Already be Pr
31、esent at Diagnosis.” Early diagnosis and management of prediabetes can reduce the risk of both type 2 diabetes and cardiovascular disease,39,Summary,The prevalence of DM and IGT is increasing rapidly as a result of lifestyle changes, urbanization and longevity. China is currently the second on the l
32、ist of the top ten countries with the highest DM burden Estimated that as the population of China reaches 1.3 billion in the early 21st century, 700,000 new cases of type 2 diabetes occur every year among 24-74 year-old HbA1c and CVD risk factors control with current treatment is poor; In China, 81%
33、 Of total direct medical cost for patients with complications Even IGT are associated with increased cardiovascular risk and mortality driven largely by postprandial hyperglycaemia,40,Conclusion,Prediabetes (IGT) might be Optimal Time for Intervention of Diabetes and CVD Prevention,Early Diagnosis of Prediabetes and DM is essential,41,Thank you !,
