With 121 million people with diabetes, China has one of the highest rates of diabetes in the world.1 More than half of the people with diabetes live in cities, and Tianjin rank among the largest urban areas in China. Tianjin’s population has more than doubled since 1995 to around 16 million people2 and an estimated 9.7% of the adult population now suffering from diabetes.3
In Tianjin, the government is very committed to promoting a healthy lifestyle and a balanced diet, which are key factors in tackling type 2 diabetes. The Cities Changing Diabetes initiative fits well into the National Health and Planning Commission’s agenda and will support other initiatives to halt the progress of type 2 diabetes.
In Tianjin, the government is very committed to promoting a healthy lifestyle and a balanced diet, which are key factors in tackling type 2 diabetes.
The Cities Changing Diabetes initiative fits well into the National Health and Planning Commission’s agenda and will support other initiatives to halt the progress of type 2 diabetes. The Tianjin Medical Association and the Shanghai Diabetes Institute will lead the initial research for Cities Changing Diabetes in collaboration with the global academic institution, University College London (UCL) from the UK.
“I am confident the city of Tianjin will benefit significantly in the fight against type 2 diabetes by participating in Cities Changing Diabetes” said Mr. Xiong Zhi, Secretary General of the Tianjin Medical Association.
Lars Rebien Sørensen, former chief executive officer of Novo Nordisk welcomed the global leadership the city of Tianjin shows in the fight against urban diabetes: “It is my hope that by working in partnership through Cities Changing Diabetes, we can complement and support the city’s objective to reduce the growing type 2 diabetes burden and tackle this urgent problem”.
Various insights into vulnerability for type 2 diabetes and diabetes-related complications have emerged from the research, the most important of which are highlighted below.
Diabetes is a burden not just physically and emotionally, but also financially. Even among participants who have health insurance plans, the treatment of diabetes can be challenging in the face of financial constraints.
In Tianjin, the cost of healthcare and pharmaceutical medicines often drives people with diabetes to seek alternative, less expensive treatment options. Some participants have to ‘budget’ their medication or make a choice about which resources they will have to do without. This seems to allow for a viable market of counterfeit medicines that are informally advertised as ‘miracle cures’. Though participants acknowledge that these are not real alternatives and may lead to even greater expenses in the long run, many participants do not know how else to manage a situation of financial limitations.
Many participants in Tianjin feel that diabetes is not a ‘serious’ disease, and therefore do not pay much attention to everyday diabetes care. However, once diabetes-related complications occur, they dramatically impact beliefs and attitude towards the illness: suddenly, it is taken much more seriously.
Furthermore, diabetes diagnosis can be experienced as a traumatic event and some report feeling that diabetes was an early death sentence, either literally or in that it takes away the pleasures and spontaneity of life.
Beliefs about what causes diabetes are equally important, as they determine the behaviours people will engage to avoid developing the disease. Participants mentioned causes like: poor food, lack of exercise, lack of diabetes education, overworking, poor mental health or escesive stress/anxiety, water and air quality, food quality, low-grade oil, pesticies, genetically modified food, hormones and chemical additives to food.
Whether having diabetes or not, the consensus among our participants is that there cannot be enough information on diabetes treatment and prevention. Poor diabetes literacy was identified as a cause of its increasing prevalence in China.
Some participants mentioned how insufficient education ultimately also endangers the health of people with diabetes, who are vulnerable to misleading advice, advertisements or compromised treatment avenues. Misconceptions about what causes diabetes need to be tackled in order to reduce its occurrence. Some participants expressed that had they known about diabetes beforehand, they would have taken the necessary measures to avoid developing it in the first place.
Doctors’ comprehensive understanding of the disease was also seen as being of significant importance. This gave the participants the confidence to manage their condition and to ask questions when their confidence was lacking.
Diabetes can be a weighty emotional burden. Feelings of guilt and regret over the state of their health were common among participants in Tianjin. Many also experience anxiety about the genetic risk factors of diabetes, and express great worries that their children will inherit the disease. Depression is a frequent comorbidity in Tianjin.
While some people take a nonchalant attitude towards the care of their diabetes, for others this responsibility is very serious. When their health outcomes do not meet their expectations or match their efforts, they are extremely disappointed. In addition, seeing or feeling the effects of diabetes on their physical state causes many people a significant amount of grief over their deteriorating health.
Diagnosis was, in many cases, experienced as an end to life as they had known it before, and was thus accompanied by much sadness and anxiety.
“Tianjin is the fifth-largest urban area in China – with a population of 11 million today that’s set to grow to nearly 15 million in the next 15 years. As China’s National Development Plan sees tens of millions pour into cities in the next decade, it’s critical we learn from cities like ours to solve future problems.
With our economic development has come improved quality of life. But as we grow we also face challenges – and one of those is urban diabetes. The Tianjin Health & Family Planning Commission takes diabetes prevention and control very seriously, investing a lot in scientific research, clinical treatment, and community health centers. This work is paying off, yet the population with diabetes is still growing.
It’s a long journey requiring the collaboration of multiple partners, including city leaders and planners, the social sector, and academic partners: that’s why we’re pleased to be a part of Cities Changing Diabetes.“