Controlling blood glucose advised in fighting diabetes

Fasting blood glucose levels among Chinese adults have been increasing, signaling potential health risks, experts say.

A study recently published in Nature Communications by a team from Fuwai Hospital at the Chinese Academy of Medical Sciences found that from 2010 to 2018, the average fasting blood glucose levels rose from 5.7 mmol/L to 5.9 mmol/L among men aged 25 and older, while levels among women increased from 5.6 mmol/L to 5.8 mmol/L.

According to the 2024 Chinese Guidelines for Diabetes Prevention and Treatment, the normal FBG reference range for healthy individuals in a fasting state is 3.9 to 6.1 mmol/L. An FBG level exceeding 7 mmol/L may indicate diabetes.

The study, based on a survey of 790,000 adults, also showed that in 2018 an estimated 498,600 cardiovascular disease deaths among people aged 25 and older in China were attributed to high FBG — an increase of nearly 150,000 deaths, or more than 40 percent, compared with 2010.

As living standards continue to improve, so does the intake of carbohydrates, fats and sugar, leading to overweight and obesity, said Zhang Jinping, chief physician in the endocrinology department at China-Japan Friendship Hospital in Beijing.

"Especially, visceral fat buildup can cause insulin resistance and raise blood sugar levels," she said.

Lifestyle habits also contribute, including prolonged sitting at work, staying up late, irregular eating and lack of exercise, all of which can impair pancreatic islet function and the body's ability to regulate blood glucose, she said.

At Zhang's hospital, outpatients whose FBG exceeds 5.6 mmol/L are advised to undergo diabetes screening. "Half of people with high FBG will develop diabetes within 10 years," she said.

Zhang Man, deputy secretary-general of the nutrition literacy branch of the China Association of Health Promotion and Education, said long-term unmanaged high FBG can lead to multi-organ damage, including kidney failure, vision loss due to retinopathy, and limb numbness or pain from peripheral neuropathy.

"It may even trigger life-threatening acute conditions such as diabetic ketoacidosis, heart failure or renal failure," she said.

Controlling hyperglycemia requires a comprehensive approach, including lifestyle interventions, blood glucose monitoring and, if needed, hypoglycemic medications. Key measures include reducing intake of refined carbohydrates, increasing consumption of high-fiber foods such as whole grains and legumes, and engaging in at least 150 minutes of moderate-intensity exercise per week. Maintaining a healthy body mass index between 18.5 and 23.9 and regularly monitoring blood glucose levels are also recommended.

"Adults over 40 should check FBG annually. High-risk groups, such as people with obesity or a family history of diabetes, should be screened every six months for early detection," Zhang said.

Zhou Xianghai, deputy director of the endocrinology department at Peking University People's Hospital in Beijing, explained that an FBG level between 6.1 and 7 mmol/L is considered impaired fasting glucose. Two consecutive tests showing FBG levels equal to or above 7 mmol/L confirm a diabetes diagnosis.

"Now many physical examination programs include FBG testing, so more people can detect the risk of developing diabetes early, even before symptoms like excessive hunger, thirst, urination and weight loss appear," she said.

However, Zhou said the public need not panic. She suggested using the Chinese Diabetes Risk Scorewhich factors in BMI, blood pressure, waistline and family history — before conducting further tests like FBG, glycosylated hemoglobin and oral glucose tolerance tests.

Routine use of a home glucometer is necessary only for patients already diagnosed with diabetes, she added.

China has seen a sharp rise in diabetes prevalence in recent years. According to the Report on the Nutrition and Chronic Diseases Status of Chinese Residents (2020), the diabetes rate among adults aged 18 and older rose from 9.7 percent in 2012 to 11.9 percent in 2018, making China home to the world's largest diabetes population.

The report also noted that the rates of diagnosis, treatment and control remain low: only 38 percent of cases are diagnosed and 34.1 percent treated.

China's trend mirrors the global surge in diabetes, with prevalence rising from 7 percent to 14 percent between 1990 and 2022, according to World Health Organization estimates. Over the same period, the number of cases climbed from 200 million to 830 million.

In 2021, diabetes and related kidney disease caused more than 2 million deaths worldwide. High blood glucose accounted for around 11 percent of cardiovascular deaths, WHO data show.

"To bring the global diabetes epidemic under control, countries must urgently prioritize the prevention, diagnosis and management of diabetes, as well as the prevention and management of risk factors such as obesity," said Martin Taylor, WHO representative to China.

Measures should include regulating unhealthy foods, taxing sugary products and improving access to affordable, healthy food and physical activity options, he said.

Taylor also emphasized the importance of early screening and management for high-risk individuals, including those with prediabetes.

"Countries should go beyond universal insurance by implementing national diabetes programs that ensure continuous care, reliable medicine supplies and patient support," he said.