Diabetes Ailing 114 Million Chinese Risks Ravaging Health 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.

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“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 come.”

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

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“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.”

Obesity Link
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.

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“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.”

15 Pounds Heavier
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.

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“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.

Herbal Remedies
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.

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“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: Natasha Khan in Hong Kong at nkhan51@bloomberg.net; Daryl Loo in Beijing at dloo7@bloomberg.net

To contact the editor responsible for this story: Jason Gale at j.gale@bloomberg.net