Type 1 Diabetes in China: Building a comprehensive evidence base of its coverage, cost and care (3C)

Project status: 
Start date: 
Completion date: 

Type 1 diabetes (T1D) is caused by destruction of the insulin-producing cells of the pancreas, typically due to an auto-immune reaction. It can affect people of any age, but usually occurs in children or young adults and T1D is the most common endocrine and metabolic conditions in childhood. People with T1D need injections of insulin every day in order to control the levels of glucose in their blood and without insulin they will die.

Broadly, however, current care and education for people with T1D are not well understood or documented in China and the prospects for people with T1D are poor. More information is needed on how T1D is being diagnosed and managed in order to supply the firsthand information when establishing standard of treatment and policy.


International Diabetes Federation (IDF) and Chinese Diabetes Society (CDS)


To describe coverage, cost and care of T1D in two regions of China – Beijing and Shantou.


This study used mixed-methods including medical chart review, questionnaire and qualitative interview to research three arms: coverage, cost and care. It started in four tertiary hospitals, three secondary hospitals and four primary health facilities in Beijing, and two tertiary hospitals, two secondary hospitals and two primary health centers in Shantou, China. Two additional tertiary hospitals in Beijing were involved in the coverage arm of the study. T1D participants are recruited from a 3-year list generated by each hospital and from those attending the outpatient clinic or admitted to the inpatient ward. Health care professionals and government officials were also interviewed to understand the technical and policy barriers to T1D patient management.

Outstanding point of 3C study

The measurement of the costs of T1D applied a combined ‘‘bottom-up, top-down’’ approach, developed to identify and validate data from all available sources. Data reported by patients or their parents (for those under the age of 15) during the face-to-face personal interviews was supplemented with information from hospital billing departments and audits of patients’ medical records (‘‘bottom-up’’ approach). Data from Government officials and routine statistics on health services were also used (‘‘top-down’’ approach).


  • On-site investigation was completed at the end of April in 2012
  • Information of more than 1600 hospitalized patients was collected for the 1st C, the Coverage, to estimate the incidence and prevalence of T1DM
  • 869 questionnaire investigation and 804 medical chart review were conducted for the second C and the third C, the cost and the Care, to analyze the economic burden and health service
  • 132 government officers and medical staffs were interviewed with quasi-structured questionnaire to support the analysis of health economics and health service
  • Abstract “Costs of Type 1 diabetes mellitus in Beijing and Shantou, China. Results from 3C study: coverage, costs and care” was published on Journal of Diabetes Investigation, Volume 3, Supplement 1 November 2012: 139 - 140
3c-publications.pdf220.11 KB