This study investigated the prevalence, awareness, and control rates of diabetes in a large population in Wuhan, China. We found that 18.80% of the elderly residents had T2DM. In addition, 77.14% of the participants were aware that they had diabetes, and 41.33% of them had diabetes under control. This study found that the prevalence rate of T2DM in Chinese individuals aged ≥ 65 is high, and thus, suggests that more improvement is necessary despite increase in awareness and control rates.
According to a national survey of a large population, the overall prevalence of diabetes in individuals aged ≥ 60 years is 20.2% , which is approximately consistent with the prevalence identified in the present study. The prevalence of T2DM in residents aged ≥ 65 in Shenzhen is approximately 22.5% , which is slightly higher than that found in the present study. Additionally, a national-level data from the NHANES in the United States showed that the prevalence of diabetes in individuals aged ≥ 65 years is 21.2% , which is similar to that identified in the present study. These data indicate that the prevalence of diabetes varies slightly between different regions in China, with increased urban development and population aging, but still the prevalence of T2DM has remained comparable to that in developed countries. Therefore, to counter the high prevalence of diabetes, it is important to improve the awareness and control rates of diabetes in patients. In the present study, 77.14% of the participants were aware that they had diabetes, and 41.33% had controlled diabetes. According to previous studies in other regions in China, the awareness rate of diabetes was < 60%, and the control rate was approximately 30% [24, 25]. However, in some European nations and the US, which have relatively higher medical facilities, the national awareness and control rates of diabetes exceeded 70% and 50%, respectively [23, 26]. These data indicate that the awareness and control rates of diabetes in China have improved than those in the past, and diabetes health education programs have progressed. However, compared with rates in the developed countries, China would need more aggressive diabetes prevention and control.
The results of the present study showed that the prevalence of T2DM was higher in women than in men, which is consistent with results of other studies conducted in Asia [27–29]. Previous studies have suggested that the difference could be attributed to variability in risk factors for diabetes prevalence between men and women, or to women's longer life expectancy . Women also had higher rates of diabetes awareness and control than men in the present study. This may be attributed to the fact that women use medical services more, have a higher awareness of social security, and have easier access to health services than men . In addition, due to the higher prevalence of diabetes in women, those with diabetes may pay more attention to the disease, and thus, have higher awareness and control rates than men.
The present study revealed that older individuals with higher education levels had higher awareness and control rates of diabetes than those with lower education levels. This is consistent with the results of some studies [32–34]. Previous studies have confirmed that education level is positively correlated with the health literacy level in patients with diabetes . The individuals with higher education are more self-conscious about health maintenance and know more about diabetes, and thus, consciously take steps to manage diabetes. A study based in the US has shown that obesity is associated with reduced awareness of diabetes, with obese individuals having lower blood sugar control levels than those with normal weight . This finding is consistent with findings of the present study. Moreover, some observational and experimental studies suggest that unhealthy lifestyles, such as alcohol consumption, are associated with poor diabetes control , which is consistent with the results of the present study.
The present study found age, BMI, and central obesity to be risk factors for diabetes prevalence, which is consistent with results of previous studies on older individuals [21, 37]. With rapid development of the economy and urbanisation, the way of living has changed significantly in Chinese individuals. Chinese consumers have shown a sharp increase in consumption of meat and reduction in consumption of cereals. People are less physically active and adopt a sedentary lifestyle, which has increased the obesity rates in Chinese population and increased the risk of diabetes [38–40]. Previous studies have shown that smoking, drinking, and lack of physical exercise are closely associated with incidence of T2DM [41, 42]. However, these associations were not observed in the present study. This may be because we investigated participants' current behaviour rather than past behaviour, and some subjects may have changed their lifestyle after being diagnosed with T2DM, which may have affected the results.
To circumvent the high prevalence of diabetes and insufficiency of blood glucose control, the relevant government departments should continue to strengthen the prevention and management of patients with diabetes. First, to increase the early screening of patients with diabetes, early identification is crucial for the primary prevention of diabetes, especially in high-risk groups. Second, health workers should strengthen the management of patients with diabetes, regularly perform blood glucose testing, examine for complications, and impart self-management knowledge education in patients with diabetes. Finally, the government can adopt lifestyle intervention policies, lifestyle interventions can prevent or delay diabetes progress, advocating residents insist on physical exercise regularly, pay attention to weight, low salt, low fat, and low oil diet health education, which will help residents to develop a healthy lifestyle, improve lipid metabolism, maintain a healthy weight, and reduce the risk of T2DM.
This study has some limitations. First, due to the cross-sectional nature of the study, the causal relationship between T2DM and some risk factors could not be inferred; therefore, longitudinal studies are needed to verify the conclusions. Second, the sample population comprised elderly people residing only in Wuhan, which may have caused selection bias. However, the large sample size helped reduce the bias. Finally, dietary habits, family history, and other chronic diseases associated with diabetes were not included as variables in the study.