Epidemiology: Diabetes in China .

1. Epidemiology: Diabetes in China. Aging population and rising overweight and obesity are driving diabetes epidemic

2. Key findings • Datamonitor Healthcare's key findings Epidemiology: Diabetes in China

3. Datamonitor Healthcare’s key findings Epidemiology: Diabetes in China 3

4. Disease overview • Diabetes definition and ICD codes Epidemiology: Diabetes in China 4

5. Diabetes mellitus definition • Diabetes mellitus includes: type 1 diabetes, formerly called independent-dependent diabetes mellitus; type 2 diabetes, historically called non-independent-dependent diabetes mellitus; and gestational diabetes. It is a complex metabolic disorder in which there are persistently elevated concentrations of blood glucose caused by autoimmune destruction of the pancreatic beta cells (type 1 diabetes mellitus) or by insulin resistance coupled with relative insulin deficiency (type 2 diabetes mellitus). • Type 1 diabetes is mainly diagnosed in children below the age of 15 years, while type 2 diabetes is mainly diagnosed in adults above 15 years. An estimated 90–95% of diabetes cases are type 2. • Since 1999, the World Health Organization (WHO) has defined diabetes as a fasting blood glucose of ≥7.0mmol/l (126mg/dl) or a two-hour blood glucose of ≥11.1mmol/l (200mg/dl). Epidemiology: Diabetes in China 5

6. Diabetes in China forecast • Epidemiologic forecast results Epidemiology: Diabetes in China 6

7. Diabetes forecast Catastrophic increase in prevalent population in China • In 2012, Datamonitor Healthcare estimates that there were 115.3 million prevalent cases of diabetes in China. • Of all the prevalent diabetes cases in 2012, more than half (63.2 million) were in urban populations. • In the Tier 1 cities of Beijing, Guangzhou, Shanghai, and Tianjin, there were 6.4 million prevalent cases – 1.8 million cases were in Beijing, 2.3 million in Shanghai, 1.3 million in Guangzhou, and almost 1 million were in Tianjin. • Over the forecast period, diabetes prevalence will increase by approximately 41% across China, with cases nearly doubling in urban populations. However, rural cases are forecast to decline due to demographic transition from rural to urban living. • The main drivers for the increase in diabetes are increasing urbanization rates, which in turn are associated with increased obesity, and population aging and growth. 7 Epidemiology: Diabetes in China

8. Age distribution of diabetes patients • Diabetes prevalent cases are mostly concentrated in the 40–69 year age groups. These age groups will continue to contribute the majority of cases during the forecast period. • However, prevalent diabetes cases in the 40–49 year age group will decline over the forecast period, signifying the impact of demographic changes as the Chinese population ages. As a result of the aging population, prevalent cases in the 50–59 and 60–69 year age groups will increase over the forecast period. • Prevalent cases in the 20–29 and 30–39 year age groups will remain somewhat constant over the forecast period due to population aging and the low risk of developing diabetes in these age groups. Epidemiology: Diabetes in China 8

9. Diabetes prevalence is set to sore in China Why is diabetes increasing in China? • Between 2012 and 2030, the number of prevalent type 2 cases in China will increase substantially by 41% (to 162.7 million prevalent cases), an average annual percentage change of 2.4%. • The main drivers for the increase in type 2 diabetes are increasing urbanization rates (which are in turn associated with increased obesity) and population aging and growth. • These updated estimates show a substantial increase from estimates based on Yang et al. (2010) which suggested that China had approximately 90 million people with diabetes. The estimated increase presented in this analysis by Datamonitor Healthcare represents the availability of new and updated epidemiologic data. • The increase in estimated diabetes prevalence in China is real and is attested by increasing obesity rates in the country since obesity is the major risk factor of type 2 diabetes. • Obesity in China, defined as a body mass index of 27.5 or higher, is described to have increased from approximately 3% to 11% in men and from 5% to 10% in women from 1993 to 2009 (Xi et al., 2012). • Furthermore, urbanization in China presents a classical epidemiologic transition where chronic diseases like diabetes become more prevalent than infectious diseases. • Population changes, particularly population aging and the increase in urbanization, are major demographic drivers for the diabetes epidemic in China. Moreover, risk factors associated with urbanization also play a major role in driving up diabetes numbers in China. For example, increases in obesity rates and a decline in physical activity due to lifestyle and occupational changes are responsible for increased prevalent cases of type 2 diabetes. Epidemiology: Diabetes in China 9

10. Conclusions and key takeaways . Epidemiology: Diabetes in China 10

11. Conclusions • Diabetes prevalence in China presents a public health time bomb as the disease burden increases at an unbearable pace. • Population changes, particularly population aging and the increase in urbanization, are major demographic drivers for the diabetes epidemic in China. Moreover, risk factors associated with urbanization also play a major role in driving up diabetes numbers in China. • Escalating obesity rates and a decline in physical activity due to lifestyle and occupational changes are responsible for increased prevalent cases of type 2 diabetes. • China is therefore the largest single diabetes market and presents opportunities for growth for anti-diabetic drugs. Epidemiology: Diabetes in China