Wang Yueqing, Ren Jie, Chai Xin, Wang Yachen, Lu Zilong, Dong Jing, Guo Xiaolei, Yin Xuejun, Zhang Juan, Tang Junli, Ma Jixiang, Shao Ruitai
School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China.
BMC Endocr Disord. 2024 Dec 18;24(1):270. doi: 10.1186/s12902-024-01796-x.
The continuum management of diabetes remains under-evaluated in China. This study aimed to estimate the proportions of diabetes adults at each stage of the cascade of care framework in Shandong, China.
We conducted a secondary analysis using the 2018 China Adult Chronic Disease and Nutrition Surveillance (CACDNS) data in Shandong. This nationwide cross-sectional survey was conducted between September and November 2018, investigating the major chronic diseases among Chinese adults through interviews, physical examinations, and laboratory tests. We employed the cascade model to examine the proportion of diabetes adults, including both type 1 and type 2, from diabetes screening, diagnosis, pharmaceutical and non-pharmaceutical treatments, to single and comprehensive management targets, and quantified the attrition between each stage. Diabetes screening was defined as participants reported to have ever received a blood glucose test. Diabetes diagnosis was defined as: 1) fasting plasma glucose (FPG) ≥ 126 mg/dL, or 2) 2-h oral glucose tolerance test (2 h-OGTT) ≥ 200 mg/dL, or 3) hemoglobin A1c (HbA1c) ≥ 6.5%, or 4) self-reported diabetes. Diabetes management targets included: 1) single glycemic target of personalized HbA1c level, 2) comprehensive ABC targets of personalized HbA1c level, blood pressure (BP) < 140/80 mm Hg, and low-density lipoprotein cholesterol (LDL-c) level < 2.6 mmol/L, 3) lifestyle target of not currently smoking. The estimated proportion was calculated through self-reported diabetes status and FPG, 2h-OGTT and HbA1c. The number of diabetes cases in Shandong was extrapolated using the 2018 provincial census data for adults aged 18 years and above (N = 80.6 million). The cascade of diabetes care was further examined by age, sex, and Basic Public Health Service (BPHS) enrollment.
This secondary analysis included 8,462 individuals (47.8% males, median age: 49.0), among whom 12.4% had diabetes (self-reported: 4.2%, newly diagnosed: 8.2%) and 41.1% had prediabetes. In 2018, an estimated 9.2 million adults in Shandong had diabetes, with 6.4 million (69.6%) receiving diabetes screening but 6.2 million (67.7%) remaining unaware of their conditions. Among self-reported diabetes adults, 2.7 million (86.4%) and 2.8 million (89.6%) received pharmaceutical and non-pharmaceutical treatment, respectively. Of those with treatments, 1.2 million (58.2%) met personalized glycemic target. A rapid decline, however, was observed in BP (31.1%) and LDL-c (39.3%) control among diabetes patients with multimorbidity (≥ 2 diseases). Ultimately, 0.1 million self-reported diabetes adults (3.8%) achieved the ABC targets. BPHS Enrollment slightly improved comprehensive management with ABC targets.
A significant unmet need exists for diabetes adults from screening to management, particularly the comprehensive management of glycemia, BP and LDL-c levels among those with multimorbidity. Tailored strategies and appropriate allocation of healthcare resource is needed to addressing gaps in care continuum and reduce long-term disease burden.
在中国，糖尿病的连续管理仍未得到充分评估。本研究旨在估计中国山东省糖尿病患者在照护框架各个阶段的比例。
我们使用2018年山东省成人慢性病与营养监测（CACDNS）数据进行了二次分析。这项全国性横断面调查于2018年9月至11月进行，通过访谈、体格检查和实验室检测对中国成年人中的主要慢性病进行调查。我们采用级联模型来研究1型和2型糖尿病患者从筛查、诊断、药物和非药物治疗到单一及综合管理目标的比例，并量化各阶段之间的流失情况。糖尿病筛查定义为参与者报告曾接受过血糖检测。糖尿病诊断定义为：1）空腹血糖（FPG）≥126mg/dL，或2）口服葡萄糖耐量试验2小时（2h-OGTT）≥200mg/dL，或3）糖化血红蛋白（HbA1c）≥6.5%，或4）自我报告患有糖尿病。糖尿病管理目标包括：1）个性化HbA1c水平的单一血糖目标，2）个性化HbA1c水平、血压（BP）<140/80mmHg和低密度脂蛋白胆固醇（LDL-c）水平<2.6mmol/L的综合ABC目标，3）目前不吸烟的生活方式目标。估计比例通过自我报告的糖尿病状态以及FPG、2h-OGTT和HbA1c计算得出。利用2018年山东省18岁及以上成年人的省级人口普查数据（N = 8060万）推算出山东省的糖尿病病例数。通过年龄、性别和基本公共卫生服务（BPHS）登记情况进一步研究糖尿病照护级联。
这项二次分析纳入了8462人（男性占47.8%，中位年龄：49.0岁），其中12.4%患有糖尿病（自我报告：4.2%，新诊断：8.2%），41.1%患有糖尿病前期。2018年，山东省估计有920万成年人患有糖尿病，其中640万（69.6%）接受了糖尿病筛查，但仍有620万（67.7%）未意识到自己的病情。在自我报告患有糖尿病的成年人中，分别有270万（86.4%）和280万（89.6%）接受了药物和非药物治疗。在接受治疗的患者中，120万（58.2%）达到了个性化血糖目标。然而，在患有多种疾病（≥2种疾病）的糖尿病患者中，血压（31.1%）和LDL-c（39.3%）控制情况出现了快速下降。最终，10万自我报告患有糖尿病的成年人（3.8%）实现了ABC目标。BPHS登记在一定程度上改善了ABC目标的综合管理。
糖尿病患者从筛查到管理存在重大未满足需求，尤其是患有多种疾病患者的血糖、血压和LDL-c水平的综合管理。需要制定针对性策略并合理分配医疗资源，以填补照护连续体中的差距并减轻长期疾病负担。
