Quan Jianchao, Zhao Zhenping, Wang Limin, Ng Carmen S, Kwok Harley H Y, Zhang Mei, Zhou Sunyue, Ye Jiaxi, Ong Xin Jiong, Ma Robyn, Leung Gabriel M, Eggleston Karen, Zhou Maigeng
School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
The National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Xicheng District, 100050, Beijing, China.
Lancet Reg Health West Pac. 2023 Jan 14;33:100690. doi: 10.1016/j.lanwpc.2023.100690. eCollection 2023 Apr.
The prevalence of diabetes has risen sharply in China. Improving modifiable risk factors such as glycaemia and blood pressure could substantially reduce disease burden and treatment costs to achieve a healthier China by 2030.
We used a nationally representative population-based survey of adults with diabetes in 31 provinces in mainland China to assess the prevalence of risk factor control. We adopted a microsimulation approach to estimate the impact of improved control of blood pressure and glycaemia on mortality, quality-adjusted life-years (QALYs), and healthcare cost. We applied the validated CHIME diabetes outcomes model over a 10-year time horizon. Baseline scenario of status quo was evaluated against alternative strategies based on World Health Organization and Chinese Diabetes Society guidelines.
Among 24,319 survey participants with diabetes (age 30-70), 69.1% (95% CI: 67.7-70.5) achieved optimal diabetes control (HbA1c <7% [53 mmol/mol]), 27.7% [26.1-29.3] achieved blood pressure control (<130/80 mmHg) and 20.1% (18.6-21.6) achieved both targets. Achieving 70% control rate for people with diabetes could reduce deaths before age 70 by 7.1% (5.7-8.7), reduce medical costs by 14.9% (12.3-18.0), and gain 50.4 QALYs (44.8-56.0) per 1000 people over 10 years compared to the baseline status quo. The largest health gains were for strategies including strict blood pressure control of 130/80 mmHg, particularly in rural areas.
Based on a nationally representative survey, few adults with diabetes in China achieved optimal control of glycaemia and blood pressure. Substantial health gains and economic savings are potentially achievable with better risk factor control especially in rural settings.
Chinese Central Government, Research Grants Council of the Hong Kong Special Administrative Region, China [27112518].
中国糖尿病患病率急剧上升。改善可改变的风险因素，如血糖和血压，可大幅减轻疾病负担和治疗成本，以在2030年实现更健康的中国。
我们利用对中国大陆31个省份成年人进行的具有全国代表性的糖尿病患者人群调查，评估风险因素控制的患病率。我们采用微观模拟方法，估计改善血压和血糖控制对死亡率、质量调整生命年（QALY）和医疗成本的影响。我们在10年时间范围内应用经过验证的CHIME糖尿病结局模型。根据世界卫生组织和中国糖尿病学会指南，将现状的基线情景与替代策略进行评估。
在24319名年龄在30 - 70岁的糖尿病调查参与者中，69.1%（95%CI：67.7 - 70.5）实现了最佳糖尿病控制（糖化血红蛋白<7%[53 mmol/mol]），27.7%[26.1 - 29.3]实现了血压控制（<130/80 mmHg），20.1%（18.6 - 21.6）实现了两个目标。与基线现状相比，糖尿病患者实现70%的控制率可使70岁前的死亡人数减少7.1%（5.7 - 8.7），医疗成本降低14.9%（12.3 - 18.0），每1000人在10年内获得50.4个质量调整生命年（44.8 - 56.0）。最大的健康收益来自包括严格控制血压至13 /80 mmHg的策略，特别是在农村地区。
基于全国代表性调查，中国很少有糖尿病成年人实现血糖和血压的最佳控制。更好地控制风险因素，特别是在农村地区，有可能带来显著的健康收益和经济节约。
中国中央政府、香港特别行政区研究资助局[27112518]。
