中国糖尿病领域新挑战（英文）

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 1 Medical and Health Annual Encyclopaedia Britannica, 1999 32 Death from Diabetes 2.90 Million (5.2%of total 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 Region Death 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 et al, 2005 The Rising Challenge of Diabetes 3 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 4 Prevalence of overweight / obesity in China (20-70 years) Overweight/ obesity (BMI 25 kg/m2) (WHO criteria) Data from National Nutrition Survey (1992), the Working Group on Obesity in China (2002) Agestandardized Prevalence (%) 5 Prevalence of overweight/obesity in Chinese children Gu D, et al. Diabetologia 46:1190, 2003 *Screening with FPG only 11 Prevalence of IGT in all age groups was higher than that of Diabetes Prevalence of IGT and Diabetes in 11 provinces, China Prevalence （ %） 0 2 4 6 8 10 12 20-30 30-40 40-50 50-60 60 Diabetes IGT Chin J Epidemiol. 1998;19(5):282-285. 12 Shanghai Diabetes Institute Isolated fasting 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 13 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 diabetesNewly diagnosed diabetes (FPG test)NGTPrediabetes Hu DY, Pan CY,Yu DM. Eur Heart J 2006;27:25739. China Heart Survey dysglycemia is common in patients with CAD 14 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(%) threeyear cumulative incidence rates incidence rates per year 1999-2001, n=5628 2002-2004, n=2709 15 Chinese individuals with IGT progress to type 2 diabetes faster than American individuals with IGT 2hPG levels of IGT controls in DaQing Study and DPP were similar (mean value 160mg/dL) 17.2 11.1 13.3 0 2 4 6 8 10 12 14 16 18 20 Chinese BMI 22.4kg/m2 Chinese BMI 27.5kg/m2 American BMI 34.2kg/m2 Incidence/100pys 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. 16 Da Qing IGT intervention Study 577 IGT 519 Control 4% IGT 0.4% NGT The appearance of ECG consistent with CHD IGT and the risk of CVD Diabetes Care 1993:16.150-15617 IGT and Atherosclerosis - Study from PLA General Hospital in China * * * IGTNGT DM IGT IGT NGT NGT DMDM N: 97(NGT), 51(IGT), 73(DM) Adjusted by age and sex * P1.1 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 Endocr. 109:11011107. 延迟或预防死亡 68,230 ( 2,0003,000) 34 Diabetes mortality continues its steady escalation Freid VM, et al. National Center for Health Statistics, 2003. Year Age adjusted death rate relative to 1980 cerebrovascular disease 40 60 80 100 120 140 1980 1990 2000 Heart disease Cancer Diabetes 35 Cause of death in China Data from National Disease Surveillance System of China (19912000) Top 3 fatal diseases in 2000 1,412,999 2,488,266 1,530,423 Cause of death in China 36 Motality of Diabetes in Urban Chinese Sources: Ministry of Health of China: Annual Statistical Reports of Death, injuries and Cause of Death 200137 WPDD 2002. /downloads/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 Present at Diagnosis.” Early diagnosis and management of prediabetes can reduce the risk of both type 2 diabetes and cardiovascular disease 38 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 list 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% Of total direct medical cost for patients with complications Even IGT are associa