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China—leading the way in diabetes research
Comment
China—leading the way in diabetes research When looking for examples of the effects of population ageing, economic growth, and rural-to-urban migration on trends in obesity and diabetes, there is no better country to refer to than China.1 Its legacy reporting systems and near obsession with data collection has meant that there is intimate and reliable knowledge obtained from massive and well-maintained datasets of both temporal trends and their drivers—including the effects of migration.2 In a country with a prevalence of diabetes between 9·7% and 11·6% (up from 2·5% in 1994),3 which equates to the largest number of people with diabetes in one country, this information is absolutely essential for health-system planning. Researchers in China have also clearly shown that following the so-called western-centric model of thinking about diabetes does not suit a Chinese population;4 BMI cutoffs for obesity, HbA1C cutoffs for diabetes, and treatments for diabetes have all been redefined for use in a Chinese setting after meticulous research. Thus—as could perhaps be appropriate to a country progressing from lower to higher income status— research in China has been tailored to address questions necessary to improve its own population’s health. Additional benefits could been seen globally, however, because China acts as a clear lens through which similar transitions occurring in other countries can be viewed and interpreted, especially those with poor availability of data, for example in sub-Saharan Africa.5 Nevertheless, as time has progressed, Chinese researchers have looked outside the fields of epidemiology and public health and embraced the wide range of research from subcellular and genetics to clinical trials.6 They have also done this without neglecting the need to answer unaddressed questions of public health relevance, including the necessity to find solutions to ensure that appropriate treatment and prevention is delivered in an affordable way.7
www.thelancet.com/diabetes-endocrinology
This range of diabetes research from China is beautifully encapsulated in the set of 35 abstracts that The Lancet Diabetes & Endocrinology are publishing to coincide with presentations at the Chinese Diabetes Society meeting (Xiamen, China; Nov 16–19, 2016). From more than 100 high-quality abstracts that were submitted, after peer review and much discussion, we selected ten for oral presentations and 25 for poster presentations. The selected abstracts span fields from genetics to health systems, epidemiology, and clinical trials; and look at diabetes, its risk factors, and its interactions with other diseases. All of the abstracts selected have potentially tangible benefits for human health. These abstracts are a celebration of the excellent diabetes research being done in China. Weiping Jia, Helena Wang, *Justine Davies Shanghai Diabetes Institute, Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China (WJ); The Lancet, Beijing, China (HW); and The Lancet Diabetes & Endocrinology, London EC2Y 5AS, UK (JD) [email protected] WJ declares no competing interests. HW and JD declare no competing interests. 1
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Tian Y, Jiang C, Wang M, et al. BMI, leisure-time physical activity, and physical fitness in adults in China: results from a series of national surveys, 2000–14. Lancet Diabetes Endocrinol 2016; 4: 487–97. Bi Y, Wang L, Xu Y, et al, for the 2012 China Noncommunicable Disease and Risk Factor Surveillance in Migrant Workers Study Group. Diabetes-related metabolic risk factors in internal migrant workers in China: a national surveillance study. Lancet Diabetes Endocrinol 2016; 4: 125–35. Ma RCW, Lin X, Jia W. Causes of type 2 diabetes in China. Lancet Diabetes Endocrinol 2014; 2: 980–91. Yang W, Weng J. Early therapy for type 2 diabetes in China. Lancet Diabetes Endocrinol 2014; 2: 992–1002. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants. Lancet 2016; 387: 1513–30. Jia W. Diabetes research in China: making progress. Lancet Diabetes Endocrinol 2016; published online June 28. http://dx.doi. org/10.1016/S2213-8587(16)30094-8. Jia W, Tong N. Diabetes prevention and continuing health-care reform in China. Lancet Diabetes Endocrinol 2015; 3: 840–42.
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China—leading the way in diabetes research When looking for examples of the effects of population ageing, economic growth, and rural-to-urban migration on trends in obesity and diabetes, there is no better country to refer to than China.1 Its legacy reporting systems and near obsession with data collection has meant that there is intimate and reliable knowledge obtained from massive and well-maintained datasets of both temporal trends and their drivers—including the effects of migration.2 In a country with a prevalence of diabetes between 9·7% and 11·6% (up from 2·5% in 1994),3 which equates to the largest number of people with diabetes in one country, this information is absolutely essential for health-system planning. Researchers in China have also clearly shown that following the so-called western-centric model of thinking about diabetes does not suit a Chinese population;4 BMI cutoffs for obesity, HbA1C cutoffs for diabetes, and treatments for diabetes have all been redefined for use in a Chinese setting after meticulous research. Thus—as could perhaps be appropriate to a country progressing from lower to higher income status— research in China has been tailored to address questions necessary to improve its own population’s health. Additional benefits could been seen globally, however, because China acts as a clear lens through which similar transitions occurring in other countries can be viewed and interpreted, especially those with poor availability of data, for example in sub-Saharan Africa.5 Nevertheless, as time has progressed, Chinese researchers have looked outside the fields of epidemiology and public health and embraced the wide range of research from subcellular and genetics to clinical trials.6 They have also done this without neglecting the need to answer unaddressed questions of public health relevance, including the necessity to find solutions to ensure that appropriate treatment and prevention is delivered in an affordable way.7
www.thelancet.com/diabetes-endocrinology
This range of diabetes research from China is beautifully encapsulated in the set of 35 abstracts that The Lancet Diabetes & Endocrinology are publishing to coincide with presentations at the Chinese Diabetes Society meeting (Xiamen, China; Nov 16–19, 2016). From more than 100 high-quality abstracts that were submitted, after peer review and much discussion, we selected ten for oral presentations and 25 for poster presentations. The selected abstracts span fields from genetics to health systems, epidemiology, and clinical trials; and look at diabetes, its risk factors, and its interactions with other diseases. All of the abstracts selected have potentially tangible benefits for human health. These abstracts are a celebration of the excellent diabetes research being done in China. Weiping Jia, Helena Wang, *Justine Davies Shanghai Diabetes Institute, Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China (WJ); The Lancet, Beijing, China (HW); and The Lancet Diabetes & Endocrinology, London EC2Y 5AS, UK (JD) [email protected] WJ declares no competing interests. HW and JD declare no competing interests. 1
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3 4 5
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Tian Y, Jiang C, Wang M, et al. BMI, leisure-time physical activity, and physical fitness in adults in China: results from a series of national surveys, 2000–14. Lancet Diabetes Endocrinol 2016; 4: 487–97. Bi Y, Wang L, Xu Y, et al, for the 2012 China Noncommunicable Disease and Risk Factor Surveillance in Migrant Workers Study Group. Diabetes-related metabolic risk factors in internal migrant workers in China: a national surveillance study. Lancet Diabetes Endocrinol 2016; 4: 125–35. Ma RCW, Lin X, Jia W. Causes of type 2 diabetes in China. Lancet Diabetes Endocrinol 2014; 2: 980–91. Yang W, Weng J. Early therapy for type 2 diabetes in China. Lancet Diabetes Endocrinol 2014; 2: 992–1002. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants. Lancet 2016; 387: 1513–30. Jia W. Diabetes research in China: making progress. Lancet Diabetes Endocrinol 2016; published online June 28. http://dx.doi. org/10.1016/S2213-8587(16)30094-8. Jia W, Tong N. Diabetes prevention and continuing health-care reform in China. Lancet Diabetes Endocrinol 2015; 3: 840–42.
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