Diabetes in China: A Weighty Problem

This traditional greeting in China, especially in Beijing, shows just how important food is for the country’s nearly 1.4 billion people. These days, however, one also increasingly hears, “Ni pang le!” (My, you’re fat!). Professor Shen Qu from Shanghai No. 10 People's Hospital has no doubts as to why obesity has become a problem in China. “Economic progress has changed our lifestyle,” he says. “On the one hand, we now have enough to eat, which wasn’t always the case throughout our history. On the other, people are exercising less and less.” High caloric intake coupled with low levels of physical activity lead to obesity and all of its negative effects, especially diabetes — more precisely, type 2 diabetes.    

“With about 114 million people suffering from diabetes and a risk group that encompasses 40 to 60 percent of the population, it’s clear that most of the people in the world with diabetes now live in China,” says Qu, who is one of China’s leading endocrinologists. The initial signs of diabetes, such as fatigue and thirst, are merely annoying, but as the disease progresses they can become life-threatening and even deadly. Diabetes also leads to higher direct costs in China’s healthcare system, so it has an indirect impact on the entire economy as well.

Stopping the continued spread of diabetes poses many challenges. For one thing, diagnosing diabetes is difficult, because the symptoms of the disease’s early stages, when it can still be controlled, could also be those of other illnesses. Both people and doctors need to be made aware of this. Like other hospitals and clinics, Shanghai No. 10 People's Hospital therefore regularly stages presentations for people at risk and is running an intense campaign of public service announcements in various media. The hospital has also helped to create a set of treatment guidelines for the Chinese Diabetes Society. The guidelines summarize all the recommendations for the diagnosis and treatment of diabetes, which are based on the latest research results from China and around the world.    

“EMD Serono in Shanghai is also working to raise awareness of diabetes. That is not surprising, given the fact that several variations of Glucophage®— a prescription drug for treating diabetes that was developed by Merck KGaA, Darmstadt, Germany in 1957 — are still part of the company’s portfolio today. “Glucophage® is based on the active ingredient metformin hydrochloride, which is recognized as the ‘gold standard’ for diabetes treatment,” says Catherine Yu, a former physician who now serves as Director of Marketing at EMD Serono in Shanghai, a dynamic city with more than 24 million inhabitants. How does Yu do her job in a country that’s nearly as big as Europe?

“We focus on those 40 to 60 large cities whose high average incomes make the risk of diabetes greater than in other metropolitan areas,” Yu explains. “You have to understand that people who can switch from a bicycle to a car will do so, and will therefore get less exercise.” Among other things, Yu is responsible for targeting e-marketing campaigns at the roughly 50,000 doctors in China who specialize in treating diabetes. 

“These physicians often do not earn even as much as US$2,000 per month, and they are also not very familiar with digital media,” says Yu. EMD’s 320 representatives in China (as of fall 2014) talk with around 8,000 Chinese physicians each year. They visit the doctors weekly or monthly as needed, and provide them with information about the latest research results. “In August 2014 alone, we documented around 300 published articles on metformin,” says Yu. The EMD representatives also explain the treatment guidelines and provide information brochures to doctors and patients.

“We also hold a Merck KGaA, Darmstadt, Germany Forum every year in China that focuses on endocrine and metabolic diseases such as thyroid gland dysfunction — and diabetes, of course,” says Jim Jin, who, among other things, is the head of the Metabolism business unit responsible for diabetes and thyroid products. As Jin explains, EMD has established a network that benefits physicians and extends far beyond China. “Our activities here are carried out in strict compliance with EMD’s corporate governance guidelines,” says Jin.

The top priority of the company’s marketing activities is the optimal treatment of diabetes and to raise awareness of the measures for its prevention, which include good nutrition, a healthy lifestyle, and exercise. This approach is working, although research has only just begun as to why Chinese people are more susceptible to diabetes than North Americans, despite their lower average body mass index. “It is possible that the problem is genetic and has as much to do with physique as with certain parts of the body — such as the hips and stomach — where fat tends to be deposited,” says Qu. He believes that home cooking is definitely part of the solution. “Chinese people should eat out less often and instead go back to preparing meals themselves using traditional ingredients,” says Qu. He is referring to Western fast-food chains as well as Chinese restaurants.

Chinese markets do in fact offer a huge variety of foods for home preparation, and the products are amazingly fresh. For example, fish are almost always sold live, even if they’ve been scaled, and are taken home in plastic bags filled with water. But what about the food stands that offer shiny brown roasted ducks — the stands that always have the longest lines? “It is not the fat itself that leads to obesity, but rather the amount that is taken in, combined with the nature of an individual’s metabolism,” Qu says. 

Still, old habits die hard, even if people are aware they have a problem. For example, the adult exercise equipment that can now be found in more and more parks in China is used mostly by people who are already physically fit. In other words, those who conduct research on diabetes, treat it, and try to raise awareness of the negative consequences of prosperity, still have a long way to go.    

Type 2 diabetes is a disorder of the sugar metabolism. On the one hand, body tissue develops a partial resistance to insulin, one of the body’s own hormones, which is responsible for metabolizing the glucose that is dissolved in the blood. On the other, the limited function of the beta cells in the pancreas causes a shortage of insulin. The active ingredient metformin hydrochloride corrects the insulin resistance by making tissues such as the liver and the muscles receptive to insulin uptake. 

This process simultaneously reduces glucose production in the liver and enhances glucose uptake in the muscles, where the glucose is stored as glycogen or burned to produce energy. The result is the restoration of the normal glucose level — the most important objective in the treatment of type 2 diabetes. The British UKPDS study has shown that metformin not only reduces the glucose content in the blood but also significantly lowers the risk of long-term complications such as a heart attack or a stroke.    

Bristol-Myers Squibb has been manufacturing and marketing EMD’s antidiabetic agent Glucophage® in China since 1999. In 2017 EMD, which is based in Darmstadt, Germany, will begin manufacturing Glucophage® with delayed active ingredient release, as well as other drugs for treating metabolic diseases, at a new facility in Nantong, China. The facility, which is currently under construction, will initially cover 40,000 square meters. Sales of Glucophage® have increased by more than 20 percent annually in China over the last few years. 

EMD is also active in a variety of ways in other countries whose residents are becoming increasingly susceptible to the risk of diabetes as a result of rising prosperity. For example, in May 2014 EMD Serono conducted a campaign in the Middle East in which 8,675 people had their blood sugar tested in just eight hours. Among other things, the campaign resulted in an entry in the Guinness World Records book.