Trends and regional differences in glycemic control of patients with type 2 diabetes in China, 2009–2013
Did you know China has more people with type 2 diabetes (T2DM) than any other country? According to the International Diabetes Federation (IDF), 116 million adults in China live with T2DM—more than the entire population of Mexico. For these patients, keeping blood sugar under control is life-saving: a glycated hemoglobin (HbA1c) level below 7% (a 3-month average of healthy blood sugar) lowers the risk of serious complications like kidney failure, blindness, and heart disease. But how well have Chinese patients managed their blood sugar over time? And do outcomes vary by where they live?
A 2022 study published in the Chinese Medical Journal sheds light on these questions. Led by researchers from Peking University People’s Hospital, the Chinese PLA General Hospital, and Peking University First Hospital, the analysis uses data from the China National HbA1c Surveillance System (CNHSS)—a nationwide program tracking T2DM outpatients from 2009 to 2013. With 956,352 patients included, it’s one of the largest studies of its kind in China.
How the Study Worked
The team conducted a retrospective analysis (looking back at existing data) of CNHSS records. Patients were recruited consistently: each hospital invited the first seven qualified patients daily until 400 participants per site were enrolled (over 3 months). Trained staff used a standardized questionnaire to collect information on age, sex, body mass index (BMI, a measure of weight relative to height), diabetes duration, and HbA1c levels. The study was approved by the Ethics Committee of the Chinese PLA General Hospital, and all patients gave written informed consent.
Key Findings: Blood Sugar Trends and Regional Gaps
1. Overall Trends: More Moderate Control, Less Good Control
From 2009 to 2013, three clear patterns emerged:
- Very high blood sugar (HbA1c ≥9%): Dropped from 33.3% to 30.4% (a small but meaningful decline).
- Moderately high blood sugar (HbA1c 7–<9%): Rose sharply from 38.1% to 47.1% (more patients moved away from dangerous levels but didn’t reach the target).
- Good control (HbA1c <7%): Fell from 28.6% to 22.6% (a 21% drop—fewer patients hit the gold standard for healthy blood sugar).
In addition, patients were slightly younger in 2013 (mean age 58.7 years overall) compared to 2009, and the median diabetes duration dropped from 4.7 to 4.1 years—meaning more newly diagnosed patients were included later on. BMI remained stable (mean >24 kg/m²), consistent with China’s high rates of overweight and obesity (key T2DM risk factors).
2. Diabetes Duration Matters
How long someone has had T2DM changed outcomes:
- Short duration (1–5 years): Both good control (HbA1c <7%) and very poor control (HbA1c ≥9%) decreased, while moderate control rose.
- Medium duration (5–10 years): Trends were similar to short duration—fewer patients at either extreme, more in the middle.
- Long duration (≥10 years): Good control (HbA1c <7%) and moderate control increased, while very poor control fell. This suggests longer-term patients are more engaged in care—possibly because they’ve experienced complications or received consistent support.
3. Age: Middle-Aged Adults Hit Hardest
All age groups saw fewer people hitting the HbA1c target over time, but the biggest drop was in 45–64-year-olds—from 35.9% to 26.2%. This is worrying because middle-aged adults often balance work, family, and health, making consistent care harder to access.
4. Regional Differences: South Leads, Northeast Lags
The most striking finding was how much outcomes varied by location. When pooling data from 2009–2013:
- Highest good control: South region (37.2%).
- Lowest good control: Northeast region (26.4%).
- Improving regions: Southwest (from 28.3% to 38.0%, a 34% increase) and Northwest (32.9% to 35.5%, an 8% increase).
- Declining regions: South (decrease), East (9.1% drop), Central (30.3% drop), North (34.5% drop), and Northeast (40.0% drop).
Even after adjusting for age, sex, hospital type, diabetes duration, and BMI, patients in the Northeast were 62% more likely to have poor control than those in the South. The Southwest had the lowest increased risk (11%) compared to the South.
What This Means for Patients and Policymakers
These results tell a complex story:
- The good news: Fewer patients have dangerous blood sugar levels (HbA1c ≥9%).
- The bad news: Fewer patients are hitting the healthy target (HbA1c <7%), and regional gaps are wide.
Regional differences hint at gaps in healthcare access, lifestyle factors, or local diabetes programs. For example, the Southwest and Northwest may have expanded access to medications or education, while the Northeast faced economic or healthcare system challenges.
The study’s time frame (2009–2013) is not current, but it provides a critical baseline. A 2017 study in North China found that 45.8% of T2DM patients hit the HbA1c target—higher than the 22.6% in 2013—suggesting progress, but regional gaps likely persist.
Conclusion
For patients with T2DM, this study underscores the need for regular HbA1c testing and consistent care. For policymakers, it’s a call to action: addressing regional disparities—like improving access to diabetes education, medications, and specialist care—could help more patients hit their targets. As China continues to tackle its diabetes burden, understanding these trends will be key to saving lives and reducing healthcare costs.
The study was funded by China’s Major Chronic Non-communicable Disease Prevention and Control Research program and the National Key Research and Development Program, with CNHSS data supported by Novo Nordisk China. The authors declared no conflicts of interest.
References
- Cheng J, Zhou X, Lu J, Guo X, Ji L. Trends and regional differences in glycemic control of patients with type 2 diabetes in China, 2009–2013. Chinese Medical Journal 2022;135:1637–1638. doi.org/10.1097/CM9.0000000000001907
- Saeedi P, Petersohn I, Salpea P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Research and Clinical Practice 2019;157:107843. doi.org/10.1016/j.diabres.2019.107843
- Wang J, Wang MY, Wang H, et al. Status of glycosylated hemoglobin and prediction of glycemic control among patients with insulin-treated type 2 diabetes in North China: a multicenter observational study. Chinese Medical Journal 2020;133:17–24. doi.org/10.1097/CM9.0000000000000585
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