China is now home to a quarter of the world's diabetes sufferers. That amounts to more than 100 million people — nearly 12 percent of the population. And according to The Lancet Diabetes & Endocrinology, the British medical journal which last week published a three-part series on Chinese diabetes, the patient pool is almost certain to expand dramatically. More than 600 million Chinese suffer from prediabetes, a condition in which individuals exhibit elevated blood sugar levels that can spark Type 2 diabetes if not treated.
These are epidemic conditions, and China is going to have an even harder time getting its crisis under control than the United States (where 9.6 percent of the population suffers from diabetes) and other developed nations. Genetic and other biological factors make Chinese "particularly susceptible" to Type 2 diabetes, the Lancet study's authors write. And the country's healthcare system, already struggling to provide affordable access to hundreds of millions of uninsured rural residents, isn't anywhere near ready to care for tens of millions of chronic disease sufferers.
Diabetes treatment in China currently focuses on managing complications and end-of-life care. According to some estimates, the disease could consume more than half of China's health-care spending if all patients were to receive routine, state-funded care.
Indeed, diabetes has the potential to cause the kinds of social and economic upheaval more commonly associated with infectious diseases. "In a country that has gone from economic strength to strength," the Lancet writes in an editorial accompanying the series, "the diabetes epidemic can now be viewed as a measureable hurdle to achievement of further growth and stability."
Health officials on the mainland face two challenges that counterparts in more developed nations don't. First, Chinese appear to contract the disease more easily than other people from other backgrounds. Researchers speculate that a well-documented tendency among East Asians to accumulate belly fat — a risk factor strongly associated with Type 2 diabetes — may be to blame.
Second, economic growth has promoted sedentary lifestyles and unhealthy changes in diet that will be extremely difficult to reverse. According to one study cited by the Lancet, only 11.9 percent of Chinese adults exercised routinely in 2010. The rest may have been too busy working in offices, or they may have found alternatives to physical activity: Another study cited in the Lancet series notes that Chinese men who acquired cars between 1991 and 1997 put on 1.8 kilograms (4 pounds) more weight than men who didn't.
Even if tens of millions of middle-class Chinese start going to the gym, there's no guarantee that hundreds of millions of urbanizing farmers are going to join them on the treadmill anytime soon.
Then there's the problem of what the Lancet study's authors call "Westernized diets." Particularly among the urban middle class, daily food intake now includes more sugary beverages, dietary fats, red meats, and refined grains. This may not be entirely a bad thing in a country where famine is a living memory. But such a diet can trigger pre-diabetes and full-blown Type 2 diabetes in younger, working-age members of the population. Dealing with the disease will thus require broad prevention and treatment across the whole population, rather than just the elderly.
China will need to build a primary care system capable of providing tens of millions of patients with affordable care and drugs just to keep younger sufferers in the workforce. That's not going to be cheap. From 2009 to 2013, China invested more than $350 billion in health-care reform, including expanded insurance coverage and public health initiatives, with mixed reviews from patients who continue to struggle with access and costs.
Spending the money better to manage diabetes will require targeting at-risk patients early on, while enlisting the Chinese state's powerful propaganda machinery to educate the Chinese public about diet and lifestyle risks. And the government needs to start soon, before this already daunting challenge becomes truly unmanageable.