The Chinese Diabetes Epidemic: Need for a Paradigm Shift in Screening and Treatment

Diabetes prevalence is on the rise and has reached epidemic levels in China. According to a new study in the Journal of the American Medical Association (JAMA), the percentage of Chinese with diabetes has surpassed that of the U.S. In China, 11.6 percent of adults – 114 million people – have diabetes. Most alarming, only 30 percent of Chinese with diabetes are aware they have the disease.

Ninety-five percent of Chinese citizens have health coverage and overall health spending in the country might hit $1 trillion by 2020. Despite these expenditures, there is still a major shortfall in identifying, screening and treating populations who are at-risk for diabetes.

How do health care providers and government leaders address this?

In China and elsewhere, urgent action is needed to expand screening initiatives to reach more patients. Bi-directional screening, where testing for an infectious illness (such as TB or HIV) is combined with a non-communicable disease screen (such as diabetes or cancer), could be key. This allows health professionals to integrate new programs into already-existing clinics. In China, the World Diabetes Foundation and World Health Organization have shown some promise in integrating diabetes and tuberculosis screenings.

However, if any real, measurable progress is to be made in reducing the 70 percent of undiagnosed diabetes cases in China, we must go beyond the traditional tactics of stakeholder meetings and training sessions that often result in only a few thousand screenings. While meetings and trainings are essential to global health intervention, they must not be considered primary tactics.

“Capacity building” is a buzz term popular in development and public health NGO spheres. If real capacity is to be built in China and beyond, we must change the paradigm of how we measure success of chronic health interventions. We should aim to screen hundreds of thousands (if not millions) of people. We must also aim to implement improvements in dozens or hundreds of hospitals & clinics, not just a few.

I’ve been screened: Now what?

Ultimately, screening initiatives fail if newly-diagnosed patients do not have access to treatments. Here are three ideas to achieve success in the fight to reduce diabetes:

• Patient education should accompany screening or treatment programs to reduce the disease’s progression.
• With more than 2,000 Mobile health applications in China already, mobile “doctors” could reinforce patient education, particularly where caregivers are in short supply.
• The Chinese government must work with payers, employers and international partners to create sustainable, market-driven models for the distribution of treatments and medicines. The private sector is essential in this effort, as was noted in a People’s Daily report this June.

The new JAMA study suggests the Chinese diabetes epidemic is greater than previously imagined, but it is not an insurmountable barrier. International partnerships are essential to overcoming the burden of diabetes in China, and it’s time for all players to re-think how they can maximize ROI on screening and treatment interventions.