China has 18 percent of the world's population but 25 percent of its diabetics. When the numbers are a staggering 1.3 billion, such a startling disparity in representation means a major public health crisis.

In 1980, less than 1% of Chinese adults had diabetes but with wealth and more food comes more opportunities to eat poorly. Though pre-diabetes is a wholly fabricated condition the evidence-based world wishes epidemiologists would stop talking about, if we do consider that, then 50% of Chinese adults have it.  

"Especially alarming is that most adults with diabetes are undiagnosed (70% of all cases), only a quarter of people with diabetes have received treatment and that the disease is controlled in just 40% of those treated," says Professor Guang Ning, one of the Series authors, and immediate past president of the Chinese Endocrine Society, who led the Chinese national survey of diabetes in 2010. 

Worryingly, say the authors, these figures herald a major epidemic of diabetes-related complications such as cardiovascular disease, chronic kidney disease, and cancer in the near future unless there is effective national intervention.

The epidemic is the result of rapid economic development and urbanization that has culminated in an "obesogenic environment" characterized by food abundance, physical inactivity, and psychosocial stress [Paper 1]. What is more, Chinese people are particularly susceptible to type 2 diabetes compared with white people, and they tend to develop the disease at a much lower body mass index (BMI). The average BMI of Chinese patients with diabetes is 25 kg/m2, compared with 30 kg/m2 in non-Asians. 

Over the past 30 years, China's standard of living and life expectancy have improved for many, but the aging population, dietary changes, reduced physical activity, and exceptionally high rates of smoking have contributed to the diabetes epidemic. The health consequences of this epidemic threaten to overwhelm health-care systems and urgent action is needed, warn the authors. 

In future decades, the double burden of an aging population and rising rates of young-onset diabetes will have an enormous toll on productivity and health-care systems [Paper 1]. Series co-leader Professor Ronald Ma, from the Chinese University of Hong Kong, explains: "Given the increased long-term risk of complications in people with young-onset diabetes, the potential economic and health burden associated with this epidemic is very alarming. In 1993, the cost of diabetes treatment in China was 2.2 billion RMB, but the projected cost for 2030 is 360 billion RMB, which highlights the critical importance of prevention."

There is much to be done, says Professor Juliana Chan from the Chinese University of Hong Kong, who co-led the series published in The Lancet Diabetes&Endocrinology: "While we await the results of long-term strategies from the China National Plan for Non-Communicable Disease Prevention and Treatment (2012-15) including tobacco control and universal screening for gestational diabetes, we advocate the use of a targeted proactive approach to identify people at high risk of diabetes for prevention, and of private-public community partnerships that make care more accessible, sustainable, and affordable focusing on registry, empowerment, and community support."

For example, community-based coordinating centers and targeted screening programs in schools and workplaces, run by trained community health workers and graduate students under medical supervision, could identify high-risk individuals and provide education about the benefits of early intervention, treatment and continuing support. Additionally, more research is needed to identify the best drug treatments for Chinese people with type 2 diabetes, who have several unique clinical characteristics. 

According to Professor Chan, "As this epidemic continues to unfold, every individual must join in the grand challenge of creating a multidimensional solution to minimize its effects on societal, family, and personal health."