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2017年6月27日，国际顶级医学期刊《美国医学会杂志》（JAMA: The Journal of the American Medical Association）（影响因子44.405）发表了北京大学公共卫生学院胡永华教授团队和中国疾病预防控制中心慢病中心王临虹教授团队合作的研究论文（http://jamanetwork.com/journals/jama/fullarticle/2633917）。该研究报告了我国成人糖尿病和糖尿病前期最新的患病率分别为10.9%和35.7%，为我国临床指南的修订完善及公共卫生决策提供了重要依据。

近年来随着我国经济发展与城市化进程的加快、人口老龄化的日益严重以及肥胖的日趋流行，糖尿病已成为影响我国居民健康的重大公共卫生问题，我国学者前期在《新英格兰医学杂志》和《美国医学会杂志》上报道了我国成人糖尿病和糖尿病前期的患病率近年来不断攀升，已引起了国际广泛关注和讨论。由于我国人口基数大，将直接影响到临床接受治疗的患者人数和费用，以及相应的公共卫生资源的合理分配，迫切需要权威性的研究数据作为证据。

课题组基于2013年中国慢性病及其危险因素调查（China Chronic Disease and Risk Factors Surveillance, CCDRFS）数据，分析了17万人的横断面复杂抽样的调查资料，并采用2010年美国糖尿病协会糖尿病和糖尿病前期的诊断标准，估计我国成人糖尿病和糖尿病前期的标化患病率分别为10.9%和35.7%。该研究发现糖尿病患病率与2010年糖尿病调查11.6%的结果基本一致，并且我国成人糖尿病患病率已接近2011-2012年美国成人的水平（12%-14%），但知晓率（36.5%）、治疗率（32.2%）和控制率（49.2%）明显低于发达国家水平，提示我国在对糖尿病患者的发现、规范管理以及有效控制等方面亟待加强。

此外，该研究还首次对我国五个人口数最多的少数民族（即藏族、壮族、满族、维吾尔族和回族）的成人糖尿病相关状况与汉族的差异进行了比较，发现我国藏族和回族人群糖尿病的患病率显著低于汉族人群，可能原因包括较低的体质指数、较高的身体活动水平、特殊的饮食习惯（经常饮用酥油茶），以及高海拔地区生活等。但由于横断面调查数据的局限性，后续研究将进一步探讨造成不同民族之间糖尿病患病状况差异的原因。

中国疾病预防控制中心慢病中心的王丽敏教授和北京大学公共卫生学院的高培研究员为该文章的共同第一作者。该工作获得了国家重大公共卫生专项基金项目和国家自然科学基金的资助。

来源：http://jamanetwork.com/journals/jama/fullarticle/2633917

June 27, 2017

Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013

Limin Wang, MPH1; Pei Gao, PhD2; Mei Zhang, MS1; et alZhengjing Huang1;Dudan Zhang, BS2;Qian Deng, PhD1;Yichong Li, PhD1;Zhenping Zhao, MS1;Xueying Qin, PhD2;Danyao Jin2;Maigeng Zhou, PhD1;Xun Tang, PhD2;Yonghua Hu, MD2;Linhong Wang, PhD1

Author Affiliations

JAMA. 2017;317(24):2515-2523. doi:10.1001/jama.2017.7596

FullText

Key Points

Question What is the prevalence of diabetes and prediabetes in China?

Findings In this nationally representative cross-sectional survey conducted in 2013 in mainland China with 170?287 participants, the estimated overall prevalence of total diabetes was 10.9%; of prediabetes, 35.7%. Tibetan and Muslim Chinese individuals had significantly lower prevalence of diabetes than Han participants.

Meaning The estimated prevalence of diabetes and prediabetes in China differs by ethnic group, and the estimated overall high prevalence may be associated with different methods of measuring hemoglobin A1c.

Abstract

Importance Previous studies have shown increasing prevalence of diabetes in China, which now has the world’s largest diabetes epidemic.

Objectives To estimate the recent prevalence and to investigate the ethnic variation of diabetes and prediabetes in the Chinese adult population.

Design, Setting, and Participants A nationally representative cross-sectional survey in 2013 in mainland China, which consisted of 170?287 participants.

Exposures Fasting plasma glucose and hemoglobin A1c levels were measured for all participants. A 2-hour oral glucose tolerance test was conducted for all participants without diagnosed diabetes.

Main Outcomes and Measures Primary outcomes were total diabetes and prediabetes defined according to the 2010 American Diabetes Association criteria. Awareness and treatment were also evaluated. Hemoglobin A1cconcentration of less than 7.0% among treated diabetes patients was considered adequate glycemic control. Minority ethnic groups in China with at least 1000 participants (Tibetan, Zhuang, Manchu, Uyghur, and Muslim) were compared with Han participants.

Results Among the Chinese adult population, the estimated standardized prevalence of total diagnosed and undiagnosed diabetes was 10.9% (95% CI, 10.4%-11.5%); that of diagnosed diabetes, 4.0% (95% CI, 3.6%-4.3%); and that of prediabetes, 35.7% (95% CI, 34.1%-37.4%). Among persons with diabetes, 36.5% (95% CI, 34.3%-38.6%) were aware of their diagnosis and 32.2% (95% CI, 30.1%-34.2%) were treated; 49.2% (95% CI, 46.9%-51.5%) of patients treated had adequate glycemic control. Tibetan and Muslim Chinese had significantly lower crude prevalence of diabetes than Han participants (14.7% [95% CI, 14.6%-14.9%] for Han, 4.3% [95% CI, 3.5%-5.0%] for Tibetan, and 10.6% [95% CI, 9.3%-11.9%] for Muslim; P?<?.001 for Tibetan and Muslim compared with Han). In the multivariable logistic models, the adjusted odds ratios compared with Han participants were 0.42 (95% CI, 0.35-0.50) for diabetes and 0.77 (95% CI, 0.71-0.84) for prediabetes for Tibetan Chinese and 0.73 (95% CI, 0.63-0.85) for diabetes and 0.78 (95% CI, 0.71-0.86) for prediabetes in Muslim Chinese.

Conclusions and Relevance Among adults in China, the estimated overall prevalence of diabetes was 10.9%, and that for prediabetes was 35.7%. Differences from previous estimates for 2010 may be due to an alternate method of measuring hemoglobin A1c.

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