48 The EconomistDecember 14th 2019
1M
ore than30 years ago, doctors in the
northern city of Daqing began a pio-
neering long-term study into the preven-
tion of type-2 diabetes, a disease which was
then thought to affect about 1% of Chinese.
When doctors, academics and officials
convened there this autumn to discuss the
conclusions and promote prevention
work, they faced a very different reality.
About 11% of Chinese adults now have the
condition, nearly the proportion in Ameri-
ca and twice the level in Britain. Type-2 dia-
betes is becoming more common globally,
but in recent years its prevalence has been
growing fastest in China.
Diabetes is a dysfunction in the body’s
regulation of blood-sugar levels. Type 1 is
rare and usually shows up early in life, trig-
gered by factors that are not yet well under-
stood. It can kill swiftly unless managed
with daily injections of insulin. Type 2 is
far more common, accounting for more
than 90% of cases worldwide. It tends to
develop in adults, especially if they are
overweight or do not exercise much. It can
usually be controlled with pills and life-
style changes, and can sometimes be re-versed. Both types, if not well-treated, can
cause complications such as organ dam-
age, blindness, strokes and heart attacks.
China has an estimated 116m diabetics,
by far the highest number of any country.
Twenty years ago it had fewer than 25m.
The dramatic increase, almost entirely in-
volving type 2s, worries the government.
The study in Daqing showed how lifestyle
changes can prevent type 2 among people
with impaired glucose tolerance, which is
sometimes a prelude to the condition. But
the country’s health-care system is ill-
equipped to ensure symptoms are de-
tected, let alone help people with them.
A big reason for the increase is that as
people get richer they often consume more
processed foods and sugary drinks. One in
seven Chinese adults is obese, including a
quarter of adults in Beijing, China’s fattest
city. The urban share of the population hasgrown from less than 20% to about 60%
since 1980. City dwellers tend to be less
physically active than people in rural areas.
There may a genetic link, too. Research
finds that ethnic-Han Chinese are acquir-
ing type 2 diabetes while younger and thin-
ner than Caucasians. Smoking is another
factor. China has one-fifth of the world’s
population but consumes one-third of its
cigarettes. About half the country’s men
smoke daily. The speed of China’s recovery
from Mao-era destitution may also be rele-
vant. Chinese experts have found that peo-
ple underfed as children are more likely to
acquire diabetes in later life.
China’s health system is not coping
well. The most recent national survey, in
2013, found that nearly 65% of China’s dia-
betics were unaware of their condition (in
America it is about 25%). Only about one-
third were getting treatment. Among those
receiving it, only about half were keeping
their blood-sugar levels within a healthy
range. Another study showed that the pro-
portion of diabetics who were managing
not only to control their blood sugar, but
also their blood pressure and cholesterol—
measures that also help avoid complica-
tions—was lower still. Some of them turn
to quack remedies.
Despite the prevalence of type 2, public
understanding of the condition is woeful.
There is little appreciation of how modern
medicine can control it. Poorly educated
people in remote communities sometimes
worry that it is infectious, says Yang Lijun,
the manager of a website for diabetics.DiabetesSugar high
BEIJING
As China puts on weight, type-2 diabetes is soaringChina
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