Prevalence trends and disease burden of diabetes and prediabetes in Chinese adults of Shanghai.

BACKGROUND: To estimate secular trends and disease burden of diabetes and prediabetes among Chinese adults. METHODS: Three population-based surveys were performed among Chinese adults in Shanghai in 2002-2003 (n = 12 302), 2009 (n = 7414), and 2017 (n = 18 960). Diabetes and prediabetes were defined using the 1999 World Health Organization (WHO) criteria. Cochran-Armitage trend test was used to examine the trends in prevalence, awareness, and glycemic control status. Disability adjusted life years (DALYs) were estimated to evaluate the disease burden of diabetes-related complications using the population attribution fraction approach based on published data. RESULTS: The age-adjusted prevalence of diabetes increased during the 15-year period (p for trend <.001) and reached 23.0% (95% CI: 22.1 ~ 24.0%) in men and 15.7% (95% CI: 15.1 ~ 16.4%) among women in 2017. The prevalence of impaired glucose tolerance peaked in 2009, whereas that of impaired fasting glucose increased continuously (p for trend <.001). The awareness of diabetes was found to increase and the glycemic control rates decreased over the three surveys. The estimated DALYs of diabetes complications were found to have increased rapidly due to the increasing prevalence of diabetes and the decreasing glycemic control rates. CONCLUSIONS: Prediabetes and diabetes affect a considerable proportion of Chinese adults in Shanghai. Our results highlight the necessary to strengthen the community healthcare system in China to guarantee extensive management of diabetes and prediabetes.

Dynamic changes in metabolic health status in Chinese adults: Multiple population-based surveys in Shanghai, China.

AIMS/INTRODUCTION: Metabolic syndrome (MS) has been increasing worldwide. The secular change in MS components, however, remains unclear. This study aimed to examine the dynamic change in metabolic health status in Chinese adults. MATERIALS AND METHODS: Three population-based surveys using multistage stratified sampling were performed in Chinese aged 35-74 years in Shanghai in 2002-2003 (n = 12,302), 2009 (n = 7,400), and 2017 (n = 19,023). MS was defined according to the Adult Treatment Panel III criteria for Asian-Americans. Generalized Estimating Equations and Cochran-Armitage Trend Test was used to assess the prevalence trend over the years. RESULTS: The prevalence of MS doubled in Chinese adults over the period (P for trend < 0.001). The largest increase occurred in younger men. Among MS components, the prevalence of high waist-circumference (HWC), high blood glucose (HBG) and high blood pressure (HBP) increased in all subjects, whereas the prevalence of high triglycerides (HTG) and low high-density lipoprotein cholesterol (LHC) increased in men but decreased in women. The increase in HBP contributed most to elevated MS, followed by HBG and HWC, resulting in the HBP-HBG-HWC the most common cluster of MS components. Metabolically unhealthy overweight also grew over the period. CONCLUSIONS: Metabolic health status has been exacerbating in Chinese adults and may increase burden of non-communicable diseases.

Performance and costs of multiple screening strategies for type 2 diabetes: two population-based studies in Shanghai, China.

INTRODUCTION: To compare the performance and the costs of various assumed screening strategies for type 2 diabetes mellitus (T2DM) among Chinese adults, and identify an optimal one for the population. RESEARCH DESIGN AND METHODS: Two multistage-sampling surveys were conducted in Shanghai, China, in 2009 and 2017. All participants were interviewed, had anthropometry, measured fasting plasma glucose (FPG), hemoglobin A1c (A1c) and/or postprandial glucose. The 1999 WHO diagnostic criteria was used to identify undiagnosed T2DM. A previously developed Chinese risk assessment system and a specific risk assessment system developed in this study were applied to calculate diabetes risk score (DRS) 1 and 2. Optimal screening strategies were selected based on the sensitivity, Youden index and the costs using the 2009 survey data as the training set and the 2017 survey data as the validation set. A twofold cross-validation was also performed. RESULTS: Of numerous assumed strategies, FPG ≥5.6 mmol/L alone performed well (Youden index of 71.8%) and cost least (US$18.4 for each case detected), followed by the strategy of DRS2 ≥8 combining with FPG ≥5.6 mmol/L (Youden index of 71.7% and US$20.2 per case detected) and the strategy of DRS1 ≥17 combining with FPG ≥5.6 mmol/L (Youden index of 72.0% and US$21.6 per case detected). However, FPG alone resulted in more subjects requiring oral glucose tolerance test (OGTT) than did combining with DRS. The strategy of FPG ≥5.6 mmol/L combining with A1c ≥4.7% achieved a Youden index of 72.1%, but had a cost as high as US$48.8 for each case identified. Twofold cross-validation also supported the use of FPG alone, but with an optimal cut-off of 6.1 mmol/L. CONCLUSIONS: Our results support the use of FPG alone in T2DM screening in Chinese adults. DRS may be used combining with FPG in populations with available electronic health records to reduce the number of OGTT and save costs of screening.