Current challenges of diabetes and metabolic disorders in China

The China Diabetes Society was established 30 years ago, when diabetes started to emerge as the most common and life-threatening metabolic disease in China, and its prevalence has continued to increase dramatically since then. In the past three decades, China has experienced social, economic and environmental transitions. Metabolic disorders, especially type 2 diabetes (T2D), obesity and cardiovascular diseases (CVDs), have contributed to a large proportion of premature deaths associated with non-communicable diseases. Alongside rapid economic growth and urbanization, the prevalence of diabetes in China has increased from 9.7% in 20081 to 11.2% in 2017,2 making China the country with the largest population with T2D in the world. Because of the low diagnosis and treatment rate, and poor management of T2D, China is facing tremendous challenges in mitigating the threat posed by diabetes and its complications. Moreover, the prevalence of prediabetes has reached 35.2%, based on a population-based survey2 using the American Diabetes Association diagnostic criteria for prediabetes. Thus, it is extremely difficult to prevent diabetes by adopting Da Qing-like3 and Diabetes Prevention Program-like approaches.4 Meanwhile, the ongoing pandemic of overweight and obesity in China has changed the face of diabetes towards diabesity, which poses a great threat to China's ambitious health goals, to be reached by 2030. However, evidence-based policies for addressing obesity and other metabolic disorders in China require enrichment, because of limited data. A deeper understanding of disease determinants, including biological and social risk factors, and the effectiveness of available interventions, is urgently needed. In this special issue dedicated to the current challenges of diabetes and metabolic disorders in China, researchers from China present data on both the microvascular complications and macrovascular complications of T2D, as well as related metabolic conditions.5 An analysis of population-attributable fractions of modifiable risk factors for microvascular complications in T2D provides a glimpse from the epidemiological perspective on how those risk factors affect the outcome of T2D in China.6 Meanwhile, for people without established diabetes, the association between stress hyperglycaemia and hospital complications after coronary artery bypass grafting is explored in a large cohort of hospital-based patients with CVD.7 Moreover, data regarding the evolving burden of non-alcoholic fatty liver disease (NAFLD),8 as well as the epidemiological characteristics and management of NAFLD in China, are enthusiastically reported concerning the emerging NAFLD pandemic.9 Here, the current status of metabolic and bariatric surgery in China is featured for the first time,10 and a comprehensive picture of surgical interventions for diabetes and obesity is presented. We believe that this input into the knowledge of chronic metabolic diseases from China into global reporting of diabetes and related conditions such as obesity, CVD and NAFLD will enable us to better inform the development of new strategies to address these devastating conditions, not only in China but also globally. The authors declare no conflicts of interest. The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer-review/10.1111/dom.15048. The data are available on request from the corresponding author.