1,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- 2008,2,Medical and Health Annual Encyclopaedia Britannica, 1999,3,3,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 RegionDeath 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,4,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,5,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),Age-standardized Prevalence (%),6,Prevalence of overweight/obesity in Chinese children & adolescents (2002),Data from 2002 National Nutrition and Health Survey,WGOC criteria,%,7,Prevalence of overweight/obesity in Chinese children & adolescents (1985- 2000),Ji C et al, Chinese Journal of Epidemiology 2004,8,9,Global prevalence of diabetes *,In 2007, the five countries with the largest numbers of people with diabetes are: India, China, United States, Russia, Germany By 2025, the largest increases in diabetes prevalence will occur in low- and middle-income countries Each year an additional 7 million people worldwide develop diabetes,* Diabetes Atlas, 3rd edition, International Diabetes Federation, 2006,10,Peoples Republic of China,Prediabetes 2003 33 million (4%) 2025 54 million (5%),Diabetes 2003 23 million (3%) 2025 46 million (4%),Sicree, Shaw, Zimmet. Diabetes Atlas. IDF. www.idf.org.2006,The prevalence of DM is increasing rapidly,11,Growing prevalence of diabetes and prediabetes in China,National Diabetes Research Group. Chin J Int Med 20:678,1981 Pan XR, et al. Diabetes 20:1664, 1997; Gu D, et al. Diabetologia 46:1190, 2003,*Screening with FPG only,12,Prevalence of IGT in all age groups was higher than that of Diabetes,Prevalence of IGT and Diabetes in 11 provinces, China,Chin J Epidemiol. 1998;19(5):282-285.,13,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,14,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 diabetes,Newly diagnosed diabetes (FPG test),NGT,Prediabetes,Hu DY, Pan CY,Yu DM. Eur Heart J 2006;27:25739.,China Heart Survey dysglycemia is common in patients with CAD,15,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(%),three-year cumulative incidence rates,incidence rates per year,1999-2001, n=5628,2002-2004, n=2709,16,Chinese individuals with IGT progress to type 2 diabetes faster than American individuals with IGT,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.,17,Da Qing IGT intervention Study577 IGT519 Control4% IGT0.4% NGT,The appearance of ECG consistent with CHD,IGT and the risk of CVD,Diabetes Care 1993:16.150-156,18,IGT and Atherosclerosis - Study from PLA General Hospital in China,*,*,*,IGT,NGT,DM,IGT,IGT,NGT,NGT,DM,DM,N: 97(NGT), 51(IGT), 73(DM) Adjusted by age and sex * P0.05, P0.005, v.s. NGT,Jing WS, Pan CY, Lu JM, et al.Chin J Endocrinol 20(2):136-139,19,The cumulative rate of CVD,Coxs Proportional Harzard Model,Xu Xj, Pan CY Tian H.et al, Chin J Gerontol.2001.,0.97,0.98,0.99,1.00,1,2,3,4,Year,NGT,IGT,DM,The CVD Risk of IGT and Diabetes- Study from PLA General Hospital in China,Cumulative rate,0,20,CODIC2 Control of Type 2 Diabetes in China,Biao X, Pan CY, Ji LN, et al. CODIC2, 2007, in press,N=1530,N=2054,N=524,21,Surveillance of Type 2 Diabetes in China,2001 hospitals distribution: Grade 3: 32(65%), Grade 2: 17(35%) 2006 hospitals distribution: Grade 3: 43(72%), Grade 2: 16(27%), Grade 1: 1(2%),Patient Population,22,BMI,Anti-obesity Treatment: 2001 2003 20061.5% 1.0% 1.0%,BMI was analysed for patients 18 years only,24.6,24.3,24.0,23.7,10,15,20,25,30,1998,2001,2003,2006,BMI (kg/m2),Pan CY. Intern Journ Endocr. & Mtab. 2005, 25 (3): 174-178.,23,WAIST,90.8,87.2,80,