Lifestyle changes have led to growing rates of diabetes among Chinese, and more needs to be done to reverse the trend, according to diabetes specialist Xu Zhangrong.

In the early 1980s, the prevalence of diabetes among adults in China was 0.67 percent. In 2008, it increased to 9.7 percent, says Xu, who is the director of the diabetes treatment center of the 306th Hospital of the People's Liberation Army.

In 2010, under the new diagnostic criteria, the prevalence hit 11.6 percent, the highest in the world. China now has one-third of the world's diabetic population, according to a study published in the Journal of the American Medical Association in 2013.

Even more concerning is the prevalence of pre-diabetes among Chinese adults - a state when blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes - was estimated to be 50.1 percent in 2010. That is to say, up to 113.9 million Chinese adults have diabetes and 493.4 million have pre-diabetes.

The majority of cases in China are Type-2 diabetes, which is preventable. Diabetes in China is linked more with sedentary lifestyle, unhealthy diet, obesity, mental pressure and aging, rather than family history, according to Xu, who is also the deputy secretary-general of Chinese Diabetes Society under the Chinese Medical Association.

However, many pre-diabetics and diabetics pay little attention to disease prevention and control, until it is too late.

Xu says many people are not aware of the risks and there is a lack of qualified healthcare professionals in underdeveloped areas.

Only 25.8 percent of diabetics are treated in China, and only 39.7 percent of those treated have adequate glycemic control, according to the study published on JAMA.

Untreated or uncontrolled, diabetes can cause many long-term and acute complications, including cardiovascular disease, retinal damage, diabetic foot (a common cause of amputation in China), kidney damage, and diabetic ketoacidosis, an acute condition that is lethal.

A survey by the Chinese Diabetes Association in 2010 with a sample of about 5,000 diabetics found that about 20 percent of them had kidney damage, 25 percent had heart disease, half of them suffered from high blood pressure and one-third of them had diabetes-related retina damage.

About 50 to 70 percent of the patients had mild to severe nerve damage that affects sensation, movement and organ function.

"Diabetes is a chronic condition that needs consistent healthcare to control its progression," Xu says.

"Medication is important, but a healthy lifestyle, including quitting smoking and alcohol, maintaining a healthy body weight and having a light diet, is also very important."

Hu Jianzhong, 56, a Beijing resident who was diagnosed when he was 33, says he is lucky to live in Beijing, where he has access to professional knowledge and useful advice on disease control.

The most important thing is to eat well and exercise, but many diabetics Hu knows do not follow this advice.

Although the Chinese Diabetes Society has done lots of work to raise public awareness of the disease, and to improve diagnosis and medical care for diabetics, there is a huge difference in accessing such medical services from area to area and an increase in diabetes in rural areas is likely if the status quo continues, Xu adds.

With people's livelihoods improving quickly in rural areas, unhealthy diets, unsafe food, less exercise and poor prevention awareness have led to rising rates of obesity and higher blood lipid levels, all of which can be triggers for diabetes.

"Diabetes has become a major challenge for China's public health," Xu says, adding the treatment for diabetic complications is expensive, and some medications are not covered by health insurance.

"More work is required to raise public awareness on the issue. Prevention is always better than treatment, especially for diabetic complications."

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