Medical care and payment for diabetes in China: enormous threat and great opportunity

PLoS One. 2012;7(9):e39513. doi: 10.1371/journal.pone.0039513. Epub 2012 Sep 26.


Background: The Diabetes Impact Study followed up a large national population-based screening study to estimate the use of and expenditures for medical care caused by diabetes in China and to ascertain the use and cost of essential basic medicines and care.

Methods: In 2009-10, the study team interviewed 1482 adults with diabetes and 1553 adults with glucose tolerance in the normal range from population-based random samples at 12 sites in China. The response rate was 67%.

Findings: After adjusting for age, sex, and urban/rural location, people with diabetes received 1.93 times more days of inpatient treatment, 2.40 times more outpatient visits, and 3.35 times more medications than people with normal glucose tolerance (all p<0.05). Adjusted expenditures for medical care were 3.38 times higher among people with diabetes than among people with normal glucose tolerance (p<0.01, unadjusted 3.97). Persons who were diagnosed with ≥ 10 years prior to the survey paid 3.75 times as much for medical care as those with ≤ 5 years of diagnosed diabetes. Among persons with diabetes, 45.2% took medication to control blood sugar, 21.1% took an antihypertensive medicine, 22.4% took daily aspirin, and 1.8% took a statin. Over the three months before the interview, 46.1% of persons with diabetes recalled seeing a doctor, 48.9% recalled a blood pressure measurement, and 54.5% recalled a blood sugar test. Over the year preceding the interview, 32.1% recalled a retinal screening and 17.9% recalled a foot examination.

Conclusions: In China, health care use and costs were dramatically higher for people with diabetes than for people with normal glucose tolerance and, in relative terms, much higher than in industrialized countries. Low-cost generic medicines that would reduce diabetes expenditures were not fully used.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ambulatory Care / economics*
  • Blood Glucose / analysis
  • China / epidemiology
  • Diabetes Mellitus / drug therapy
  • Diabetes Mellitus / economics*
  • Diabetes Mellitus / epidemiology
  • Female
  • Glucose Tolerance Test
  • Health Expenditures / statistics & numerical data*
  • Humans
  • Hypoglycemic Agents / economics*
  • Hypoglycemic Agents / therapeutic use
  • Male
  • Mass Screening
  • Middle Aged
  • Rural Population
  • Surveys and Questionnaires
  • Urban Population


  • Blood Glucose
  • Hypoglycemic Agents

Grant support

This study was funded by allocations from the Economic Study Fund of the International Diabetes Federation (IDF), a not-for-profit NGO headquartered in Brussels, Belgium, and from the Chinese Diabetes Society. The IDF's Economic Studies Fund was created from contributions that IDF solicited from Merck and Co., Novo Nordisk, Eli Lilly and Co., Takeda Pharmaceuticals North America, and GSK, Inc. These funders had no role in study design, data collection and analysis, decision to publish, preparation of the manuscript, or selection of countries in which economic impact studies were conducted. Additional resources, in the form of volunteer time, logistical support, and expertise were provided by the 12 study sites in China, by the Chinese Diabetes Society, by the Chinese-Japanese Friendship Hospital, by the Kaiser Permanente Center for Health Research, by the United States Centers for Disease Control and Prevention, by the International Diabetes Federation, and by the authors.