IMPORTANCEPrevious studies have shown increasing prevalence of diabetes in China, which now has the world's largest diabetes epidemic.OBJECTIVES To estimate the recent prevalence and to investigate the ethnic variation of diabetes and prediabetes in the Chinese adult population. DESIGN, SETTING, AND PARTICIPANTS A nationally representative cross-sectional survey in 2013 in mainland China, which consisted of 170 287 participants.EXPOSURES Fasting plasma glucose and hemoglobin A 1c levels were measured for all participants. A 2-hour oral glucose tolerance test was conducted for all participants without diagnosed diabetes. MAIN OUTCOMES AND MEASURESPrimary outcomes were total diabetes and prediabetes defined according to the 2010 American Diabetes Association criteria. Awareness and treatment were also evaluated. Hemoglobin A 1c concentration of less than 7.0% among treated diabetes patients was considered adequate glycemic control. Minority ethnic groups in China with at least 1000 participants (Tibetan, Zhuang, Manchu, Uyghur, and Muslim) were compared with Han participants.RESULTS Among the Chinese adult population, the estimated standardized prevalence of total diagnosed and undiagnosed diabetes was 10.9% (95% CI, 10.4%-11.5%); that of diagnosed diabetes, 4.0% (95% CI, 3.6%-4.3%); and that of prediabetes, 35.7% (95% CI, 34.1%-37.4%). Among persons with diabetes, 36.5% (95% CI, 34.3%-38.6%) were aware of their diagnosis and 32.2% (95% CI, 30.1%-34.2%) were treated; 49.2% (95% CI, 46.9%-51.5%) of patients treated had adequate glycemic control. Tibetan and Muslim Chinese had significantly lower crude prevalence of diabetes than Han participants (14.7% [95% CI, 14.6%-14.9%] for Han, 4.3% [95% CI, 3.5%-5.0%] for Tibetan, and 10.6% [95% CI, 9.3%-11.9%] for Muslim; P < .001 for Tibetan and Muslim compared with Han). In the multivariable logistic models, the adjusted odds ratios compared with Han participants were 0.42 (95% CI, 0.35-0.50) for diabetes and 0.77 (95% CI, 0.71-0.84) for prediabetes for Tibetan Chinese and 0.73 (95% CI, 0.63-0.85) for diabetes and 0.78 (95% CI, 0.71-0.86) for prediabetes in Muslim Chinese.CONCLUSIONS AND RELEVANCE Among adults in China, the estimated overall prevalence of diabetes was 10.9%, and that for prediabetes was 35.7%. Differences from previous estimates for 2010 may be due to an alternate method of measuring hemoglobin A 1c .

revention and control of noncommunicable diseases is a public health priority worldwide. However, data have shown steady increases in noncommunicable diseases, especially obesity and diabetes, in many countries. [1][2][3][4] Diabetes prevalence in China increased from less than 1% in the 1980s to almost 11% in 2013. [5][6][7][8][9] In 2013, China reported having the largest number of patients with diabetes and spending the second highest amount on diabetes and its complications worldwide. 8,10,11 In addition, the population of patients with prediabetes represents a large reservoir of patients at risk of diabetes. Previous research showed low rates of awareness, treatment, and control of diabetes in China, 6-8 compared with the United States. 12 Previous national surveillance data described the prevalence and treatment of diabetes in China in 2013. 8 Another survey reported estimated diabetes prevalence of 11.2% and prediabetes prevalence of 35.2% in 2015. 13 The prevalence, awareness, and treatment of diabetes varies within populations. 3,7,8,14 Socioeconomic and behavioral factors (eg, diet, smoking) may account for this variation. Behavioral factors are important modifiable factors for diabetes prevention and management. China has launched public health campaigns to promote healthful behaviors, including tobacco control, healthful diet, and physical activity. To our knowledge, no nationally representative studies with consistent study design have comprehensively investigated trends in the prevalence, treatment, and risk factors of diabetes in China. IMPORTANCERecent data on prevalence, awareness, treatment, and risk factors of diabetes in China is necessary for interventional efforts. OBJECTIVE To estimate trends in prevalence, awareness, treatment, and risk factors of diabetes in China based on national data. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional nationally representative survey data collected in adults aged 18 years or older in mainland China from 170 287 participants in the 2013-2014 years and 173 642 participants in the 2018-2019 years.EXPOSURES Fasting plasma glucose and hemoglobin A 1c levels were measured for all participants. A 2-hour oral glucose tolerance test was conducted for all participants without diagnosed diabetes.MAIN OUTCOMES AND MEASURES Primary outcomes were diabetes and prediabetes defined accordingtoAmericanDiabetesAssociationcriteria.Secondaryoutcomeswereawareness,treatment, and control of diabetes and prevalence of risk factors. A hemoglobin A 1c level of less than 7.0% (53 mmol/mol) among treated patients with diabetes was considered adequate glycemic control.

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