Diabetes awareness and screening in high-risk populations in China: a nationwide, population-based survey

Abstract

BackgroundChina is unlikely to deliver diabetes screening to all adults because of the large size of the population; however, diabetes screening might have substantial public health benefit. Several societies, including China Diabetes Society and American Diabetes Association, recommend universal diabetes screening in older and high-risk adults, but this recommendation has not been well implemented in China. We aimed to investigate—among people recommended for screening and those not recommended—the prevalence of diabetes, the frequency and the determinants of diabetes awareness, and the rate of regular check-ups in those diagnosed with diabetes . MethodsWe analysed data from the 2007 and 2008 China National Diabetes and Metabolic Disorders Survey, in which a nationally representative sample of 46 239 people aged 20 years or older were included using a multi-stage stratified sampling method. The participants included in the screening-recommended group were all high-risk adults, and low-risk older adults. High-risk was defined as a person who was overweight with additional risk factors such as family history of diabetes, physical inactivity, hypertension, dyslipidaemia, or history of cardiovascular disease. Awareness of diabetes was defined as a self-report of any previous diagnosis of diabetes by a health-care professional among the population defined as having diabetes. Diabetes was diagnosed by an oral glucose tolerance test according to WHO diagnostic criteria. Ethical approval was granted by all the attending hospitals. Informed patient consent was given by all participants. Findings30 735 (66·5%) of 46 239 participants were included in the screening recommended group. Of these, 10 787 (35·1%) were designated as high-risk older adults, 12 329 (40·1%) as low-risk older adults, and 7619 (24·8%) as high-risk younger adults. The prevalence of diabetes was 20·5% (2211 of 10 787) in the high-risk older adults, 12·6% (1553 of 12 329) in low-risk older adults, and in 8·3% (632 of 7619) high-risk younger adults, as compared with 2·7% (419 of 15 504) in people not recommended for screening (p<0·0001). Awareness of diabetes in those with diabetes was 971 (43·9%) of 2211 high-risk older adults, 753 (48·5%) of 1553 low-risk older adults, and 173 (27·3%) of 632 high-risk younger adults, as compared with 143 (34·2%) of 419 people not recommended for screening (p<0·0001). Multivariate analysis showed that those recommended for screening had significantly increased diabetes awareness (odds ratio [OR] 1·24, 95% CI 1·16–1·32, p<0·0001) compared with those who were not recommended for screening. However, high-risk younger people did not show a significantly increased awareness of diabetes (OR 0·87, 95% CI 0·66–1·15, p=0·43). Additionally, the proportion of those attending regular health check-ups for the diagnosis of diabetes among those recommended for screening was 11 310 (36·8%) of 30 735, similar to that among those not recommended for screening (5954 [38·4%] of 15 504; p=0·24). InterpretationPeople for whom screening is recommended had a higher prevalence of diabetes compared with those for whom it is not recommended. However, albeit strongly advised, those recommended for screening did not have high diabetes awareness and fewer than half of patients were aware of their disease. More importantly, in the patients who are aware of their diabetes, only around a third had regular health check-ups. China is beginning to recognise the challenge that diabetes poses and it is of great importance to find out the future direction of diabetes solutions in policy areas. Our study suggests that much more attention and strategy is needed in China for diabetes screening in those recommended for screening, particular for high-risk younger people. FundingChinese Medical Association Foundation and Chinese Diabetes Society.