Is RFK Jr right about China's diabetes rate?

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Speaker 1 Hello, thanks for downloading the More or Less podcast. We're the program that looks at the numbers that emerge in the news, in life, and from the mouths of US politicians.
And I'm Tim Harford.

Speaker 1 The U.S. Health Secretary, Robert F.
Kennedy Jr., is on a mission to make America healthy again.

Speaker 1 Along with firing all 17 members of the Advisory Committee for Immunization Practices and canceling a campaign to encourage people to be vaccinated against flu, one of his health promotion ideas is to reduce chronic illness, specifically diabetes.

Speaker 4 He claimed that juvenile diabetes, a typical pediatrician would see one case of diabetes in his lifetime over a 40 or 50 year career.

Speaker 4 Today, one out of every three kids who walk through his office door is pre-diabetic or diabetic. 20 years ago there was no diabetes in China.

Speaker 4 Today 50% of the population is diabetic.

Speaker 1 Are his numbers right and how much of a problem is diabetes in the US and around the globe?

Speaker 1 Our guide through all things diabetic is Professor Diana Magliano. She's a diabetes epidemiologist who works at the Baker Heart and Diabetes Institute in Melbourne and Monash University in Australia.

Speaker 1 She has also co-authored two editions of the Diabetes Atlas. First things first, what is diabetes? As you may or may not know, there are two main types.

Speaker 5 The first type is type 1 diabetes, and that occurs from an autoimmune process against your pancreatic cells. And they no longer produce any insulin.

Speaker 1 Insulin is a hormone that allows us to absorb glucose from food for our body to use to power itself.

Speaker 5 Within days or sometimes even up to two weeks, if you don't have insulin, you will die.

Speaker 5 So that's the one that people get mainly in childhood, but we also see that now in young adults and older adults.

Speaker 5 And type 2 diabetes is a bit different in the sense that the biggest feature is insulin resistance. They're resistant to the insulin and they need more and more to do the same job.

Speaker 1 It's type 2 diabetes that generally hits the headlines as it makes up about 90% of all diabetes cases.

Speaker 5 It's a disease in older people, although we are seeing it now in 20s and 30 year olds. There is more lifestyle driven, lack of physical activity, smoking, hypertension, they're all drivers.

Speaker 5 But the biggest driver of type 2 diabetes is in fact obesity.

Speaker 1 Obesity may be the biggest driver, but some obese people will never develop type 2 diabetes and some slimmer people will.

Speaker 1 This is because some people and indeed some populations are genetically predisposed to developing the condition.

Speaker 5 Certain racial groups are more likely to get type 2 diabetes, the white people are protected, but people from Asia and India and Pakistan and Indigenous people have got a much higher risk of type 2 diabetes and a stronger family history of type 2 diabetes as well.

Speaker 1 Diana has been looking at global diabetes statistics for decades.

Speaker 1 In the Diabetes World Atlas, she used data from government health agencies and some extrapolation to calculate that 590 million people around the globe are currently living with diabetes.

Speaker 1 The majority of them have type 2 diabetes. This number is likely to be an underestimate, due to some countries underdiagnosing, but it is the best number we have.

Speaker 1 But wait a minute, if 590 million people have diabetes globally, and 20 years ago, there was no diabetes in China.

Speaker 4 Today, 50% of the population is diabetic.

Speaker 1 That would mean 700 million people people in China have diabetes. And that would mean that every single person diagnosed with diabetes is Chinese.

Speaker 1 And in fact, that the rest of the world has negative 100 million diabetics. Now I'm not a doctor, but that doesn't seem very likely.
So RFK Jr.'s 50% figure can't possibly be right.

Speaker 5 No, it's at about 12%.

Speaker 5 Ah. Type 2 diabetes is always lower in the rural communities who were still living on the land, having their traditional diets.

Speaker 5 But in urbanized communities where they're living in big urban cities with pollution and junk food and affluent life, diabetes is really taking a hold. And that's what's happening in China.

Speaker 1 However, Diana says that RFK Jr.'s claim about the numbers shooting up does reflect what she found when she was compiling her diabetes atlas.

Speaker 5 The birds atlas that we wrote in 2000, it was under 1% of people in China would have diabetes. And now in the 11th edition of the Atlas, 11.9% of Chinese adults aged 20 to 79 have diabetes.

Speaker 1 That could partly be due to undercounting or underdiagnosis.

Speaker 1 But it's also likely that lifestyle factors and urbanisation, plus genetic disposition and a rapidly aging population, have made these numbers shoot up.

Speaker 1 However, the rise was from under 1% to just under 12%,

Speaker 1 not 50%.

Speaker 5 There's no country that's got 50%. So the highest country is Pakistan with about 30, 31%.

Speaker 5 And some of the Pacific islands got really high.

Speaker 1 One such place that demonstrates how quickly incidence of diabetes can spread is Nauru, a small island in Micronesia to the northeast of Australia.

Speaker 5 That was an island made of phosphate and they sold it their phosphate and then got rich and stopped moving and didn't have to work and they got large and they got diabetes and they couldn't grow their food anymore because the land was destroyed from all the phosphate.

Speaker 5 So they had to buy all this food from New Zealand and Australia and it was energy-dense foods and they were living off junk food.

Speaker 5 So diabetes prevalence hit 34% overall and it was 50% in some of the older age groups in Nauru.

Speaker 1 All that happened in the space of 30 years. Currently, the increase in incidence of diabetes is higher in certain areas than others.

Speaker 5 Much higher burden of type 2 diabetes in middle-income countries and high-income countries, even though the high-income high-income countries presented with it earlier and the low- and middle-income countries are still developing, the burden now for them is much higher because of their genetics and their ethnic group.

Speaker 1 One of the important things to note when looking at the data around diabetes in countries such as the US and the UK is that although the percentage of people who have diabetes is growing, the rate of new cases is stabilising and in some places reducing.

Speaker 5 Prevalence is generally rising everywhere because we're living longer with diabetes because we're managing it so much better.

Speaker 5 European white populations, we actually think the incidence of type 2 might be starting to stabilise, in fact.

Speaker 5 But it doesn't mean that prevalence doesn't go up because people are still staying alive with it.

Speaker 1 An alarming development in higher income countries is that people are being diagnosed with type 2 diabetes at a younger age.

Speaker 5 So I looked at eight countries. It was going, certainly going up in Japan and Korea, and it was going up less in the white European populations.

Speaker 1 In the US this problem extends to children.

Speaker 4 Today one out of every three kids is pre-diabetic or diabetic.

Speaker 1 The Health Secretary is right in that the Centers for Disease Control and Prevention

Speaker 1 recently reported that one in three American children aged between 12 and 17 are pre-diabetic.

Speaker 1 However, the National Health and Examination Survey, which provided the data for the CDC report, also found that 70% of teenagers with pre-diabetes do not develop diabetes.

Speaker 1 So while that figure is alarming, it is fixable. But how many American children actually have type 2 diabetes?

Speaker 5 It's really low. For type 2, it's 0.67 in 1,000 children in kids under 20.

Speaker 1 That's 1 in 1500. Although we are better at treating diabetes, it still carries a high burden of disease, especially in middle and lower income countries.

Speaker 1 Despite this, Diana says there is a sliver of hope.

Speaker 5 We can be cautiously optimistic that in at least high-income countries, we're managing to turn the tide. So the message of healthy life is getting through eventually.

Speaker 1 Thanks to Professor Diana Magliano. And that's all we have time for this week.
If you see any suspicious stats, please email in to moreorless at bbc.co.uk. Until next week, goodbye.

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