• Xinge Zhang, Hongjiang Wu, Baoqi Fan, Mai Shi, LauEric S HESH0000-0003-1581-5643Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China., Aimin Yang, Elaine Chow, KongAlice P SAPS0000-0001-8927-6764Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China.Hong Kong Institute of Diabetes and Obesity, The Chinese University of Ho, ChanJuliana C NJCN0000-0003-1325-1194Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China.Hong Kong Institute of Diabetes and Obesity, The Chinese University of , MaRonald C WRCW0000-0002-1227-803XDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China.Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hon, and LukAndrea O YAOY0000-0002-5244-6069Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China.Hong Kong Institute of Diabetes and Obesity, The Chinese University of Ho.
• Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China.
• PLoS Med. 2022 Jul 1; 19 (7): e1004045.

BackgroundLittle is known about the lifetime risk of progression to diabetes in the Asian population. We determined remaining lifetime risk of diabetes and life years spent with diabetes in Chinese people with normoglycemia and prediabetes.Methods And FindingsUsing territory-wide diabetes surveillance data curated from electronic medical records of Hong Kong Hospital Authority (HA), we conducted a population-based cohort study in 2,608,973 individuals followed from 2001 to 2019. Prediabetes and diabetes were identified based on laboratory measurements, diagnostic codes, and medication records. Remaining lifetime risk and life years spent with diabetes were estimated using Monte Carlo simulations with state transition probabilities based on a Markov chain model. Validations were performed using several sensitivity analyses and modified survival analysis. External replication was performed using the China Health and Retirement Longitudinal Survey (CHARLS) cohort (2010 to 2015). The expected remaining lifetime risk of developing diabetes was 88.0 (95% confidence intervals: 87.2, 88.7)% for people with prediabetes and 65.9 (65.8, 65.9)% for people with normoglycemia at age 20 years. A 20-year-old person with prediabetes would live with diabetes for 32.5 (32.0, 33.1) years or 51.6 (50.8, 52.3)% of remaining life years, whereas a person with normoglycemia at 20 years would live 12.7 (12.7, 12.7) years with diabetes or 18.4 (18.4, 18.5)% of remaining life years. Women had a higher expected remaining lifetime risk and longer life years with diabetes compared to men. Results are subjected to possible selection bias as only people who undertook routine or opportunistic screening were included.ConclusionsThese findings suggest that Hong Kong, an economically developed city in Asia, is confronted with huge challenge of high lifetime risk of diabetes and long life years spent with diabetes, especially in people with prediabetes. Effective public health policies and targeted interventions for preventing progression to diabetes are urgently needed.

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