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.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
Lancet Diabetes Endocrinol. 2014 Dec;2(12):969-79. doi: 10.1016/S2213-8587(14)70144-5. Epub 2014 Sep 10.
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.
2013 年，全球四分之一的糖尿病患者在中国，中国成年人中有 11.6%患有糖尿病，50.1%有糖尿病前期。许多人未被诊断、未治疗或未得到控制。这种流行病是社会快速转型的结果，导致了肥胖环境，同时传统的生活方式和饥荒时期并存，这使得中国人面临着高糖尿病和多种合并症的风险。包括社会差距和心理社会压力在内的社会决定因素与低度感染、环境污染、护理碎片化、健康素养低下、自我护理不佳和社区支持不足等因素相互作用，导致了多种亚表型和后果，特别是肾功能障碍和癌症。在中国国家慢性病防治计划（2012-2015 年）中，中国政府提出利用公共措施、多部门合作和社会动员来创造一个有利于健康的环境，并改革医疗保健系统。在等待这些长期战略的结果的同时，我们提倡采取有针对性和积极主动的方法，为预防确定处于高风险的糖尿病患者，并建立公私社区伙伴关系，使综合护理更容易获得和可持续，重点是登记、赋权和社区支持。糖尿病的社会和个人挑战的多面性需要一个多维的预防解决方案，以减轻日益增长的疾病负担。
