title: Diabetes in China: a societal solution for a personal challenge.
abstract: China has a large burden of diabetes: in 2013, one in four people with diabetes worldwide were in China, where 11·6% of adults had diabetes and 50·1% had prediabetes. Many were undiagnosed, untreated, or uncontrolled. This epidemic is the result of rapid societal transition that has led to an obesogenic environment against a backdrop of traditional lifestyle and periods of famine, which together puts Chinese people at high risk of diabetes and multiple morbidities. Societal determinants including social disparity and psychosocial stress interact with factors such as low-grade infection, environmental pollution, care fragmentation, health illiteracy, suboptimal self-care, and insufficient community support to give rise to diverse subphenotypes and consequences, notably renal dysfunction and cancer. In the China National Plan for Non-Communicable Disease Prevention and Treatment (2012-15), the Chinese Government proposed use of public measures, multisectoral collaborations, and social mobilisation to create a health-enabling environment and to reform the health-care system. While awaiting results from these long-term strategies, we advocate the use of a targeted and proactive approach to identify people at high risk of diabetes for prevention, and of private-public-community partnerships that make integrated care more accessible and sustainable, focusing on registry, empowerment, and community support. The multifaceted nature of the societal and personal challenge of diabetes requires a multidimensional solution for prevention in order to reduce the growing disease burden.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Hong Kong Institute of Diabetes and Obesity, and International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China. Electronic address: jchan@cuhk.edu.hk.
authors.forename: Juliana C N
authors.initials: JC
authors.lastname: Chan
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
authors.forename: Yuying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Shanghai Clinical Center for Endocrine and Metabolic Disease, National Clinical Research Center for Metabolic Diseases, E-Institute of Shanghai Universities, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Guang
authors.initials: G
authors.lastname: Ning
mesh_terms: D044466:Asian People; D002681:China / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D058872:Epidemics; D006297:Health Services Accessibility; D006801:Humans; D012307:Risk Factors; D012959:Socioeconomic Factors; D066252:Sociological Factors; D013315:Stress, Psychological