Gong Xi Fa Cai! Medical news in the Year of the Sheep

Chinese New Year is upon us, with businesses closing up for a long holiday and most Chinese families looking forward to a reunion. But of course people still get sick at Spring Festival and the Chinese media has been full of stories praising the heroic and dedicated doctors and nurses who forego the holiday and put duty ahead of family to stay at work.  There are stories of doctors working solo for 24 hours to keep up with all the demand during the Spring Festival. From Hubei there is the story of the man bitten by his rabid pet dog who went to the hospital and was hugely relieved to find that the infectious diseases doctor was on duty to give him a rabies injection. At Fuzhou Hospital on New Years Eve the medical and nursing staff gather together to have the "big family banquet" that they would normally have with their families at home.  And there is even a story of the doctor at a Zhejiang leper colony who was urged by his ailing patients to go home and see his family rather than spend New Year on duty at the sanatorium.

Not all doctors have been heaped with praise at Chinese New Year, however. In Guangzhou there has been an uproar among the medical community after the city authorities sent anti-corruption teams in to raid hospitals just before Spring Festival. The city disciplinary affairs committee said the inspection teams were looking for evidence of bribes and 'hongbao' (red envelopes) given by patients to doctors. The raids have so far turned up little evidence of bribery, and doctors have been indignant at being suspected of corruption. They objected to having their everyday items such as snacks being documented - and also being questioned in detail about the origin of their possessions - and even for receipts for goods. Doctors said the actions of the inspectors went beyond their powers and the actions should have been a matter for the police. One doctor said a public hospital was not a place where bribes could be openly given or solicited among colleagues - and he was also indignant that many doctors had prepared hongbao or gifts for their families which were assumed by inspectors to be bribes from patients.

Chinese New Year is also a peak risk time for influenza in China. In Guangdong it has been reported there have been 53 cases and 13 deaths from  H7N9 avian influenza. In neighbouring Hong Kong there has also been a very severe flu season caused by the regular influenza H3N2 strain which has been causing as many as 18 deaths per day in the city. There have been reports of shortages of antivirals such as Tamiflu in Hong Kong, and the flu vaccine this year has been ineffective because the H3N2 strain of flu is a new mutation that is not covered by the vaccine. Of course influenza does not stop at the border, so we can only assume that the flu toll has been equally high in mainland China.

Another major infectious disease under the microscope this week is the recent outbreak of measles  affecting more than 1200 people in Beijing. Infectious disease specialists in the capital found that most of the cases originated in wholesale clothing markets popular with  locals and international visitors - so an MMR vaccination might be a pre-requisite if you are going to the Silk Market. The analysis found that many of the cases occurred in migrant workers who (unlike Beijing residents and tourists) had low levels of measles vaccination. The researchers recommended that outreach services be set up to vaccinate migrant workers in Beijing and "the offer of measles vaccine to workers as they register to live and work in the commodity markets might be a reasonable strategy to prevent future measles outbreaks."

In other news this week - the high demand for blood products in China is driving  a thriving black market in organised gangs of donors, organised by the so-called "blood heads" who are paid thousands of RMB for supplying blood. In the field of diabetes, some Chinese endocrinologists have been blasted in the pages of the Lancet for writing a review article that recommended the use of expensive new drugs as first line treatment for diabetes. Their critics say the endocrinologists failed to mention the more effective and cheaper drugs such as metformin - and the Chinese doctors also failed to mention their financial conflicts of interest with the Big Pharma makers of the expensive new drugs.

And finally, the quality of medical education in China has been questioned in several articles published this week. The Year of the Sheep is a milestone for China's medical educators in that they are now requiring a standard 5+3 medical degree + internship program be implemented nationally. However, some commentators have said that the new system will be no better than the current haphazard postgraduate 'Masters' programs if medical graduates receive insufficient clinical experience and supervision. They also say that the internship scheme should include 'exit examinations' to ensure that trainees have actually acquired the specialist skills they have trained in. Coincidentally this week Shanghai media report that trainee doctors get little experience in anatomy because there is a national shortage of donated cadavers. Chinese culture prohibits citizens from 'donating their bodies to science' as is done in the west. This means that Chinese medical graduates get all their anatomy learning from textbooks and have very little "hands on" experience. This is worrying for students going into specialties such as surgery - as they may never have practiced techniques such as cervical spine surgery before being asked to do the real thing. Not surprising then that a special anatomy cadaver training class at Shanghai's Fudan University was heavily oversubscribed.

新年快乐!

Diabetes in China: the numbers are staggering

by Michael Woodhead

The Lancet Diabetes & Endocrinology journal is this month running a series of articles focusing n type 2 diabetes in China.  

The numbers make for grim reading: more than 12% of Chinese are reported to have diabetes (100 million people) according to US criteria (although there is some dispute over whether these  criteria may result in overestimates).  Because of the lack of awareness and lack of adequate screening and intervention programs, many of the Chinese with diabetes are undiagnosed, untreated, or uncontrolled. 

The articles say that Chinese people are especially prone to type 2 diabetes at relatively low levels of overweight, and Chinese people are more susceptible to [insulin producing] beta cell failure and deficits in insulin production. The blame, unsurprisingly, is put on China's rapid development and shift to lifestyle factors such as eating an unhealthy diet and doing less exercise. 

A second article says that there are also problems with provision of prevention and treatment programs for diabetes in China. As well, there is little research on the best forms of drug therapy for Chinese people with diabetes. Newer [and more expensive] anti-diabetes agents such as the gliptins seem ideal, but they are not currently accessible or widely used by most doctors.

The articles conclude by saying that any solution to the diabetes epidemic in China must be based on multiple strategies: there needs to be healthcare reform to make diabetes prevention and treatment more widely available through primary care and through initiatives such as diabetes nurses. There are need to be major preventive health campaigns to promote healthier eating and activity, to reduce the risk factors for diabetes in China. The articles also note that health reforms are needed to provide adequate health insurance cover and reimbursement for treatment of diabetes patients in China

China's 'diabetes epidemic' debunked

A study that appeared to show that China is experiencing a rapid rise in diabetes has been debunked by critics who say the apparent increase in diabetes was caused by the researchers measuring a different variable.
In September Dr Xu Yu of the Shanghai Jiaotong University School of Medicine published  a study in JAMA which showed that the prevalence of diabetes had increased to 12% of adults Chinese. The prevalence of 'pre-diabetes' was said to be at 50%. However in a letter published in JAMA this week Dr Kristine Faerch of the Steno Diabetes Center, Denmark, says the alarming figures published Dr Xu are a false alarm caused by the measurement of different parameters, not a true change in the rates of diabetes.
Dr Faerch says the rates of diabetes were increased by adding the HbA_1c criterion to the diagnosis of diabetes and using the lower diagnostic threshold for impaired fasting glucose of 100 mg/dL instead of 110 mg/dL.
When more conventional methods of measuring diabetes are used, the rates of diabetes are unchanged from the last study done two years ago, at around 9.7%, she notes. Also the rates of pre-diabetes will be 15% rather than the 50% suggested by Dr Xu's study, she adds.
Another letter in JAMA says Dr Xu's study would also overestimate levels of diabetes because it ignored non-residents of cities such as migrant workers, college students, and military personnel who would likely have lower levels of diabetes.

Manufacturers stop production of essential medicines after price controls

China's pharmaceutical manufacturers have stopped production of important essential medicines after price controls limited how much they could charge and profit from them, the government has conceded.
The National Health and Family Planning Commission has announced that it is now "working on a new mechanism to balance the economic interests of pharmaceuticals and the public demand for affordable and effective drugs," according to spokesman Mao Qun'an.
The move follows growing shortages of important but unprofitable drugs such as those for hyperthyroidism. In the China Daily, a report details how locally-produced anti-thyroid treatments such as methimazole (Tapazole) are no longer available for the 10 million people in China who have an overactive thyroid. Many hospitals can no longer access Chinese-made products and have to buy imported products instead.
The pricing for listed essential drugs such as Tapazole has been strictly controlled under a system introduced in 2009, but this has resulted in small profit margins for drug producers, and many of the 13 pharmaceutical companies producing the drug in China have ceased production.
Shortages of Tapazole have been noted in regional areas, but until now supply has not been a problem for major hospitals in big cities, many of which use imported drug.
The spokesman for the National Health and Family Planning Commission said: "Under a market economy, all stakeholders need to cooperate and negotiate a balance to prevent similar problems from happening again in a bid to secure the drug supply."

Doctors warn of oestrogen in meat as Henan girl develops puberty at 4 years of age

by Michael Woodhead
Doctors in Henan says the precocious puberty reported in a 4-year-old girl may have been caused by her mother's use of oestrogen-like drugs while breatfeeding or by her intake of foods such as chicken that were high in added hormones.
The girl from  Pingdangshan is reported to have developed breasts and started menstruating at the age of four. She is now undergoing treatment at the local hospital but her family say they cannot afford the 2000 RMB cost of monthly injections that she will need until the age of 12 to counter the condition, according to a report from Xinhua.
The girl comes from a poor farming family in the mountainous and deprived Ruzhou country. Her parents say the puberty effects first started to appear when she was two years old. Her family took her to the local hospital but it was only a very basic clinic and the doctor there did not have the expertise to examine or diagnose a hormonal condition in a small child. She was only diagnosed properly when they took her too the city of Zhengzhou. Even at that early age, doctors said her skeleton resembled one of an 8 or 9 year old. The Zhengzhou hospital clinicians worked out a long term treatment plan for the young girl who was already showing signs of breast development and menstruation. However, her family struggled to find the 30,000 RMB needed to pay for monitoring tests and hormonal treatment.
A doctor involved in the case siad the girl was showing body changes at 3-4 years of age that would normally only start at 8-9 years of age at the very earliest. He feared that f the girl did not get proper inhibitory treatment she would suffer physiological damage and show premature ageing.
As to the cause of the condition, he said it appeared to be due to external factors rather than an inherited or innate disease. he speculated that the premature puberty might have been caused by early exposure of the girl to high levels of sex hormones such as oestrogen. This might have occurred as she was breast fed and her mother had used medicines that contained the hormone. In addition, the precocious puberty may also have been made more likely due to hormones in the food she and her mother consumed.
"We advise families that food such as chicken, beef, soya milk and egg white can all contain high levels of oestrogen and should be eaten in only small amounts by daughters in particular."

Acarbose the first line drug for type 2 diabetes in rice-eating populations: Chinese study

by Michael Woodhead
Although metformin is the first line treatment for type 2 diabetes, the α-glucosidase inhibitor acarbose has been shown in a major Chinese trial be be a worthy alternative in patients with a marked postprandial glucose changes. 
In The Lancet Diabetes & Endocrinology, Professor Yang Wenying and colleagues from the Department of Endocrinology, China-Japan Friendship Hospital, Beijing, report the findings of a randomised controlled trial that compared the α-glucosidase inhibitor acarbose with metformin as initial treatment for type 2 diabetes.
In a study known as the MARCH (Metformin and AcaRbose in Chinese as the initial Hypoglycaemic treatment) trial they recruited 788 adult Chinese patients who were newly diagnosed with type 2 diabetes. Patients were randomly assigned to receive metformin (up to 1500 mg sustained release preparation) or acarbose (titrated gradually up to a maximum of 100 mg three times a day). At the end of the 48-week study period, acarbose was found to be as effective as metformin in terms of its HbA1c-lowering effect , and both treatment regimens achieved weight loss, although patients in the acarbose group lost slightly more weight (−0·63 kg). Patients assigned to the acarbose group also had a more favourable lipid profile, with improved HDL and lower triglycerides at 48 weeks. As expected, treatment with acarbose was associated with less postprandial hyperinsulinaemia than with metformin.
An accompanying editorial says alpha-glucosidase inhibitors remain most popular in Asian countries such as China, where rice forms a major component of the diet and the dietary contribution of carbohydrate is high.
“The results of this large study indicate that the efficacy of acarbose could be related to the carbohydrate content in the patients' diet, which suggests that acarbose would be more effective in populations with a high carbohydrate intake,” it said.
Source: The Lancet Diabetes & Endocrinology

Reference values for bone mineral density developed for Chinese infants

Clinicians from Hubei have developed reference values for lumbar bone mineral density in healthy Chinese infants and young children. 
In a study of almost 12,000 healthy children aged 0 to 3 years who underwent regular physical examinations at the Child Health Care Clinic of Hubei Maternal and Child Health, researchers obtained BMD measurements of the lumbar spine (L2–L4) with dual-energy X-ray absorptiometry and a questionnaire. They also obtained BMD values for 379 preterm infants The results showed that lumbar BMD significantly increased with age among both boys and girls, with fastest growth observed during the first postnatal year. There was no significant difference in lumbar BMD between boys and girls of similar age, either among healthy reference children or preterm infants. However, BMD values in preterm infants were significantly lower than those in term infants 3 to 8 months old after adjustment for gestational age.
There were significant positive associations between lumbar BMD of healthy children and the child's age and current weight, mother's weight gain during pregnancy, birth weight, children's outdoor activity duration and children's physical activity duration.
Source: PLOS One

Poor rural infants to be screened for PKU, thyroid and hearing disorders

China will start screening for three major diseases among infants in poor rural areas next month, said the National Health and Family Planning Commission here on Friday.
The free screening targets phenylketonuria, congenital hypothyroidism and hearing disorder and will cover about 490,000 rural newborns in 200 poverty-stricken counties of 21 provincial regions, said a commission statement.
Those who are diagnosed with the diseases will receive treatment and medical assistance from the state, according to the statement.
Phenylketonuria, also known as PKU, is a metabolic genetic disorder that can lead to learning disability, seizures and other medical problems. If patients can be diagnosed at an early age and get proper treatment, the symptoms may not develop and they can have a normal life.
Congenital hypothyroidism is another metabolic disorder under which an infant is born with a severe deficiency of thyroid function. Early diagnosis and treatment can prevent growth failure and mental retardation caused by the condition.
The central government will allocate a special fund for this program, 120 yuan (19 U.S. dollars) for each infant, the statement said.
Additionally, the commission will dispatch free dietary nutrition supplements to infants from six to 24 months in 300 poor counties so as to reduce incidence of anemia and stunting.
Source: China Daily

Chinese women with PCOS have high rates of hypertension and metabolic abnormalities

by Michael Woodhead

One in five Chinese women with Polycystic Ovarian Syndrome (PCOS) have hypertension, almost twice the rate of other women, a study from Shandong has found.

Women with PCOS also had abnormal lipid, insulin and glucose levels compared to women without PCOS according to a study conducted by Dr Shi Yuhau and co-researchers at the Reproductive Medicine Hospital Affiliated to Shandong University, Jinan.

The researchers studies 3396 women with PCOS and 1891 controls They found the prevalence of hypertension to be 19.2% in the women with PCOS, which was much higher than that in the controls (11.9%). After matching for BMI, the hypertensive PCOS group had significantly higher glucose, insulin, and lipid levels than the normotensive PCOS group; these differences were significant.

The researchers said the likelihood of long-term metabolic complications was high in hypertensive PCOS patients.

 “These findings underscore the importance of preventive strategies in women with PCOS in order to prevent hypertension,” they said.

“Cardiac risk factors associated with PCOS have public health implications and should drive early screening and intervention measures. Fasting lipid profiles and glucose examinations should be performed regularly. Treatment of the associated cardiovascular risk factors, including insulin resistance, hypertension and dyslipidaemia, should be incorporated into routine PCOS patient wellness care programmes. These results suggest that it is importance to control weight and blood pressure in women with PCOS in order to reduce their excess risk of future complications. “

Read the full study in: European Journal of Obstetrics & Gynecology and Reproductive Biology

OGTT reveals high rate of diabetes in hypertensive patients - Beijing study

by Michael Woodhead

There is a high prevalence of diabetes and newly-detected diabetes among Chinese hypertensive outpatients, Beijing researchers have shown.

About one in four hypertensive outpatients had concomitant diabetes, and approximately one in three cases were newly detected , their study found.

Dr Wang Wei and co-researchers at the Beijing An Zhen Hospital, Capital Medical University and the Beijing Institute of Heart, Lung and Blood Vessel Diseases say that additional testing of 2-hour plasma glucose with an oral glucose tolerance test (OGTT) should be added to fasting plasma glucose (FPG) assay to improve the detection rate of diabetes, especially in elderly patients.

In a study of 4942 patients attending hypertension outpatient clinics in 46 hospitals in 22 provinces of China, the researchers measured fasting plasma glucose in all patients and also did 2-hour plasma glucose testing in those without a history of diabetes.

The study found that the prevalence of diabetes was 24% (both previously and newly diagnosed cases). Among the 1202 patients with diabetes, one third were newly detected. In patients aged <45 years, 53% of cases of diabetes were newly detected. Of the 417 cases of newly detected diabetes, 55% were identified using FPG tests and the remaining 45% by 2-hPG tests. More than a quarter of patients with newly detected diabetes had FPG <6.1 mmol/L and 16.5% had FPG <5.6 mmol/L. Among the elderly patients, 32.4% had normal FPG (<6.1 mmol/L) and 24.5% had optimal FPG (<5.6 mmol/L).

The detection rate of newly diagnosed diabetes was higher in patients with low educational level, low level of medical insurance, obesity and high triglycerides.

The researchers say that currently only the fasting plasma glucose assay is routinely used in China because of its technical convenience and low cost. However, they say their findings show that adding 2-hour plasma glucose to the routine FPG assay would increase detection rates by 4.5%, and by more than 6% in the elderly.

Source: BMJ Open

Four-fold increase in diabetes rates among rural Chinese

Lifestyle changes have led to increasing incidence of diabetes among China's rural population, a senior medical official warned Friday.
The incidence rate of diabetes among adults in China's rural areas has increased from 1.8 percent in 2002 to 8.4 percent in 2010, said Wang Linhong, a senior official with the Chinese Center for Disease Control and Prevention, at a seminar held in Beijing.
The incidence rate in the countryside increased faster than in cities, though the rate was still lower than that of cities, Wang said, adding that the rural population has become a priority in diabetes control and prevention.
The national incidence rate of diabetes among adults increased from 2.69 percent in 2002 to 9.7 percent in 2010, while the rates for 2011 and 2012 were not available, according to Wang.
With rapid urbanization over the past few decades, rural people's livelihood has improved quickly, while modern agriculture requires less physical labor.
Unhealthy diet and less exercise have caused obesity and higher blood lipid levels among the rural population, which could lead to diabetes, Wang said.
Additionally, rural people are much less aware of diabetes than their urban counterparts, he said.
Nationally, only 36.1 percent of diabetes patients were aware of their condition, and 34.7 percent used medication to control their condition, according to Wang.
"Diabetes has become a major challenge for China's public health and a main task of our programs to control chronic diseases," he said.
In 2012, the Chinese government launched a plan on the control and prevention of chronic diseases from 2012 to 2015, which included efforts to increase the awareness and medication of diabetes. 

Source: Global Times

China's RMB14 billion insulin market monopolised by three western pharma companies

Demand within the Chinese insulin market has grown at a fast pace in the past decade. Over the next five years, both production and demand will continue to grow.
China is the country with the largest number of diabetics. In 2011, the market scale of diabetes medicine in China approximated RMB13.8 billion, of which, insulin medicines comprising recombinant human insulin and insulin analog accounted for 52.8%.
Insulin is a peptide hormone, produced by beta cells of the pancreas, and is central to regulating carbohydrate and fat metabolism in the body.
Insulin causes cells in the liver, skeletal muscles, and fat tissue to take up glucose from the blood. In the liver and skeletal muscles, glucose is stored as glycogen, and in adipocytes it is stored as triglycerides.
Due to high technological content and entry barriers, Chinese insulin market is monopolized by foreign corporations. In 2011, the combined market share of the three world-renowned pharmaceutical tycoons including Novo Nordisk, Eli Lilly and Company, and Sanofi Group hit 90% in the Chinese market.
By contrast, the largest domestic counterpart- Tonghua Dongbao Pharmaceutical -occupied merely 3.4% or so.
Denmark-based Novo Nordisk is not only the leader in global insulin industry, but also a major supplier in China's insulin market with the recombinant human insulin market share of 76% and the insulin analog market share of 53% in 2011.
America-based Eli Lilly and Company is the second embarking on Chinese insulin market, with the recombinant human insulin market share of 17% and the insulin analog market share of 8% in 2011.
Source: Companies and Markets

Intensive diabetes treatment reduces cardiovascular complications

Heart attacks were reduced by intensive treatment with hypoglycaemic drugs, antihypertensives and statins

by Michael Woodhead
In a long term intervention study, researchers from Dalian have shown that macrovascular complications of type 2 diabetes can be prevented through an intensive regimen of hypoglycaemic, antihypertensive and statin drugs.
When used in combination with interventions to promote better diet and more activity, the drug regimens reduced macro vascular complications by two thirds, according to Professor Yang Yu of the Department of Endocrinology at the First Affiliated Hospital of Dalian Medical University.
In a seven year study, Professor Yang and colleagues compared 'intensive' treatment with conventional treatment of type 2 diabetes in 150 patients at the hospital. Half the patients were assigned to the intensive group, and were treated with hypoglycaemic drugs, such as metformin, antihypertensives such as an ACE inhibitor, and lipid lowering drugs such as statins or a Chinese lipid-lowering herb complex called Xue-Zhi-Kang. Patients also received one on one sessions instructing them in diet and exercise.
After seven years, subclinical macrovascular complications such as heart attacks, angina and stroke occurred in 10% (seven) of the intensive treatment group and in 33% (22) of the  conventional group.
The researchers say their findings confirm those seen in the landmark UKPDS trial and show that "primary prevention of macrovascular diseases can be achieved through intensified, multifactorial intervention in patients with short-duration type 2 diabetes.
"Our approach achieved the primary prevention of diabetic macrovascular complications, implying that intensive, multifactorial intervention
should be administered to type 2 diabetic patients as soon as possible to provide the most benefits," they suggest.
"Type 2 diabetic patients should undergo intensive multifactorial interventions with individual targets for the prevention of macrovascular diseases," they conclude.
Source: Diabetes Care

Chengdu researchers show oral insulin as effective as injected insulin

An enteric coated form of insulin was as effective as NPH insulin when given orally

by Michael Woodhead

While insulin is usually given as an injection because it is broken down and inactivated in the stomach, doctors in Sichuan  have shown that it can be effective when given orally in a special enteral formulation.
Researchers from the Department of Endocrinology and Metabolism at West China Hospital, Sichuan University, Chengdu, evaluated the pharmacodynamic and pharmacokinetic profiles of orally administered enteric insulin and compare the time–action of the oral insulin capsules with a standard insulin injection formulation, neutral protamine Hagedorn (NPH) insulin.
in their study, 12 healthy volunteers received one of three doses of oral enteric insulin (50, 100, or 200 U) or one subcutaneous injection of NPH insulin (6 U) on four separate days.
Glucose infusion rates increased after administration of either NPH or oral enteric insulin. The mean times for maximal metabolic effects for 50, 100, and 200 U of oral enteric insulin were 250, 170, and 236 minutes, respectively, compared with 243 minutes for NPH insulin. The onset of action was slower for oral enteric insulin at 50 U, 100 U  and 200 U compared with NPH insulin. The maximum glucose infusion rates for oral enteric insulin treatment were lower compared with NPH insulin, although these differences were not significant.
The researchers conclude that "oral enteric insulin capsules induced significant glucodynamic effects and exhibited a time–action profile similar to that of NPH insulin in these healthy volunteers. No detectable increases in serum insulin concentration were observed in any treatment group."
Read more: Clinical Therapeutics

Doctors warned not to profiteer from blood glucose monitoring

Medical experts are calling for a regulated use of continuous glucose monitoring system (CGMS), a device that records blood sugar levels throughout the day and night, since some people are abusing the test for profit.
An updated national guideline for CGMS use was issued in Shanghai over the weekend.
"The price of CGMS test is between 720 (US$114) to 900 yuan in the country," said Dr Jia Weiping, a member of the Diabetes Branch of the Chinese Medical Association. "Some doctors prescribe CGMS unnecessarily for its high price."
CGMS is a good way to track blood sugar levels, but it is no replacement for standard blood sugar monitoring. The main advantage of continuous glucose monitoring is that it can help identify fluctuations and trends that would otherwise go unnoticed with standard blood sugar tests and intermittent finger stick measurements.
The device can record dangerously low overnight blood sugar levels which often go undetected, and reveal high blood sugar levels between meals to ensure better diagnosis and treatment by doctors.
Read more: ECNS

Only 40% of diabetes in China is diagnosed

Only 40 percent of China's estimated 92 million diabetes patients get diagnosed, which seriously undermines early treatment for sufferers and the nation's overall intervention efficiency, a leading specialist warned.
Ji Linong, president of the Chinese Diabetes Society under the Chinese Medical Association, made the remarks at an event on Tuesday to mark World Diabetes Day, which falls on Nov 14 every year.
According to Ji, the number of diabetes patients on the mainland has doubled over the past decade, and about 9.7 percent of the population aged 20 and older suffer from the chronic disease related to a high-fat diet and sedentary lifestyle.
"Early detection and treatment could well avert or delay the development of complications and help lower treatment costs," Ji said.
Diabetics who do not receive early treatment could suffer a heart attack, kidney failure or serious complications that result in amputation, he said.
Read more: China Daily