Diabetes Ailing 114 Million Chinese Risks Ravaging Budget

Diabetes may consume $22 billion,
or more than half of China’s annual health budget, if all those
afflicted with the condition get routine, state-funded care.

The disease is putting an “overwhelming burden” on the
country, according to the International Diabetes Federation,
which says China spent $17 billion, or about $194 a patient, on
diabetes last year. A study released last week found China has
114 million diabetics or 21.6 million more than the Brussels-based federation estimated in November.

Extending average care to the enlarged population of
diabetes sufferers would wipe out all of China’s additional
investment in health. The government budgeted spending 260.25
billion yuan ($42.5 billion) this year, a 27 percent increase,
on basic medical services and subsidies for a state-run health
insurance program. China’s diabetes costs will balloon, with
almost 500 million Chinese at risk of developing the disease.

“It’s very scary,” said T.H. Lam, a professor of public
health at the University of Hong Kong. “This only represents
the beginning of the diabetic epidemic. The worst is yet to

Diabetes costs an average of $1,270 per patient globally
and $8,478 in the U.S., according to the International Diabetes
. Treatment for the metabolic condition and its
associated ailments is expensive because patients with poor
blood-sugar control can develop complications ranging from heart
and stroke to gangrenous foot ulcers, blindness and
kidney failure.

Oblivious Diabetics

The most comprehensive nationwide survey for diabetes ever
conducted in China showed 11.6 percent of adults have the
disease. The study, published Sept. 3 in the Journal of the
American Medical Association
, also found that almost two-thirds
of patients treated for diabetes in China don’t have adequate
blood-sugar control and that for every person diagnosed with the
condition, at least two more will be unaware they have it.

“People with diabetes who are not under treatment or have
good control of their diabetes will quickly start to develop
complications,” said Leonor Guariguata, a biostatistician at
the International Diabetes Federation. “We know from studies in
Europe that the first cardiovascular complication in a person
with diabetes can increase the per-person annual costs
associated with the disease by at least 50 percent and by 360
percent for a major cardiovascular event, such as heart attack
or stroke.”

$500 Billion Cost

Type-2 diabetes prevalence is expanding 4 percent a year
globally, compared with 1-to-2 percent for obesity, resulting in
$500 billion in medical costs, or more than 10 percent of
health-care expenditure, the Credit Suisse Research Institute
said yesterday in a report. Ninety percent of doctors worldwide
surveyed by the institute believe the type-2 diabetes and
obesity epidemics are linked to excess sugar consumption.

“As with alcohol and tobacco, higher taxation on drinks is
the best option to reduce sugar intake and help fund the fast
growing health-care costs,” the report said.

Most of China’s diabetes sufferers have the type-2 form,
which occurs when the body stops responding adequately to
insulin, the hormone that regulates blood-sugar. Type-1
diabetes, prevalent in about 5 percent of all sufferers, is an
autoimmune disease that results from the destruction of the
body’s insulin-producing beta cells in the pancreas.

China’s diabetes prevalence is being spurred by diet and
lifestyle changes linked to the country’s economic development,
which have resulted in an increasingly overweight and obese
population, said Barry Popkin, a professor in the department of
nutrition at the University of North Carolina at Chapel Hill,
who has studied weight trends in China.

‘Tip of the Iceberg’

“This is just the tip of the iceberg,” Popkin said in an
interview. “We’re beginning to see a whole cohort of younger
Chinese that are heavier, have greater rates of obesity as well
as diabetes, and in the future this is going to go way up.”

Chinese aged 10 to 30 are about 6-7 kilograms (15 pounds)
heavier than that age group 20 years ago, mainly due to
inactivity, and diets that comprise more sugary drinks, alcohol,
refined rice, and less fiber, Popkin said. This puts them at
higher risk of developing diabetes, he said.

Half of China’s adults, or 493.4 million people, have
higher-than-normal blood-glucose levels, which put them in a
pre-diabetic state that triples their risk of full-blown
diabetes, said Guang Ning, lead author of last week’s study and
director of the National Health and Family Planning Commission’s
laboratory for endocrine and metabolic diseases.

Cheaper Treatments

“China is trying hard to control the cost of treating
diabetes as much as possible,” said Ning, who is also head of
endocrinology and metabolism at the Rui-Jin Hospital in
Shanghai. “We have been able to do this by reducing the cost of
drugs and by encouraging more people to get treatment locally.”

Thirty-five percent of Chinese citizens’ health-care costs
were paid “out-of-pocket” in 2011, down from 58 percent in
2002, after the government expanded subsidies, according to a
State Council report published in December.

China’s doctors are encouraged to prescribe the generic
medicine metformin as a first-line drug for diabetics, while
patients who prefer traditional remedies are given huang lian su
tablets, containing berberine, a plant extract shown to be
effective in treating Type 2 diabetes, Ning said. Both these
options are much cheaper than imported medicines, he added.

“The major way to reduce the economic burden is to have a
good primary care system so many of these people can be treated
there, reducing the hospital expenditure,” said the University
of Hong Kong’s Lam. “There is a golden opportunity for early
treatment or early prevention to make sure people can reduce
their risk.”

To contact Bloomberg News staff for this story:
Daryl Loo in Beijing at
Natasha Khan in Hong Kong at

To contact the editor responsible for this story:
Jason Gale at

Enlarge image
Diabetes Hospital

Diabetes Hospital

Diabetes Hospital

Wang Zhao/AFP/Getty Images

A woman waits to receive treatment as she sits in front of billboards about diabetes at a diabetes hospital in Beijing.

A woman waits to receive treatment as she sits in front of billboards about diabetes at a diabetes hospital in Beijing. Photographer: Wang Zhao/AFP/Getty Images

China's Diabetes ‘Catastrophe’ Afflicts 114 Million

Sept. 4 (Bloomberg) — The most comprehensive nationwide survey for diabetes ever conducted in China shows 11.6 percent of adults, or 114 million, has the disease. The finding, published yesterday in the Journal of the American Medical Association, adds 22 million diabetics, or the population of Australia, to a 2007 estimate and means almost one in three diabetes sufferers globally is in China. Stephen Engle reports. (Source: Bloomberg)