The Chinese Metabolic Management Centers

Abstract

From 2000 to 2021, global diabetes prevalence increased from 151 million, 4.6% of the adult population, to 537 million, 10.5% of the adult population, with predicted increase to 643 million in 2030, 11.3% of the population, and to 783 million, 12.2% of the adult population, by 2045. 1 How will this burgeoning group be treated?Current studies suggest that medical care is not usually optimized for people with diabetes. Of 733 older persons in Vietnam with type 2 diabetes and high cardiovascular disease risk, 11% achieved low-density lipoprotein (LDL) cholesterol goal, and 51% achieved glycosylated hemoglobin (HbA1c) goal. 2 In a similar study of 465 adults with diabetes in Brazil, 46% achieved HbA1c goal, 51% blood pressure goal, and 40% LDL cholesterol goal. 3 In an Iranian study of 2008 persons with diabetes, 78% had HbA1c <8%, and 87% had blood pressure <140/90. 4 In a Taiwan survey in 2011 of 5599 adults with type 2 diabetes, 35% had HbA1c <7%, 38% had blood pressure <130/80, and 56% had LDL cholesterol <100. 5 In population samples of persons with diabetes in India and Pakistan in 2016, 30% had HbA1c <7%, and 45% had LDL <100. 6 From 1999 to 2007 to 2016, US NHANES (National Health and Nutrition Examination Survey) population surveys showed an increase in prevalence of HbA1c ≥8% from 28% to 26% to 20%, in prevalence of blood pressure <130/80 from 42% to 49% to 51%, and prevalence of LDL <100 among persons with diabetes increased from 32% in 1999 to 44% in 2005 to 51% in 2008 and to 53% in 2012. 7 In a study of 2844 persons with diabetes at high cardiovascular risk in Italy, 56% had LDL cholesterol above minimum LDL goal of 100 mg/dL, and 90% had levels above the more aggressive goal of 55 mg/dL, but, for 35% of these, their physician incorrectly identified cardiovascular risk, suggesting LDL cholesterol targets that were higher than those recommended by guidelines. 8 This represents what has been termed "therapeutic inertia," the lack of treatment advancement despite treatment goals not having been attained. Using The Health Improvement Network (THIN) database of 254 925 people in the United Kingdom with incident type 2 diabetes followed for 5.3 years, two-thirds had dyslipidemia and two-thirds