Diabetes Type 2 warning India

IHT – Asia Pacific by N.R. Kleinfield published September 12, 2006
CHENNAI, India There are many ways to understand diabetes in this choking city of automakers and software companies, where the disease seems as commonplace as saris.

One way is through the story of P. Ganam, 50, a proper woman reduced to fake gold.

Her husband, K. Palayam, had diabetes do its corrosive job on him: Ulcers bore into both feet and cost him a leg. To pay for his care in a country where health insurance is rare, P. Ganam sold all her cherished jewelry. Gold, as she saw it, swapped for life.

She was asked about the necklaces and bracelets she was now wearing.

They were, as it happened, worthless impostors.

“Diabetes,” she said, “has the gold.”

And now, Ganam, the scaffolding of her hard-won middle-class existence already undone, has diabetes too.

In its hushed but unrelenting manner, Type 2 diabetes is engulfing India, swallowing up the legs and jewels of those comfortable enough to put on weight in a country better known for famine.

Here, juxtaposed alongside the stick- thin poverty, the malaria and the AIDS, the number of diabetics now totals around 35 million, and counting.

The future looks only more ominous as India hurtles into the present, modernizing and urbanizing at blinding speed. Even more of its 1.1 billion people seem destined to become heavier and more vulnerable to Type 2 diabetes, a disease of high blood sugar brought on by obesity, inactivity and genes, often culminating in blindness, amputations and heart failure.

In 20 years, projections are that there may be a staggering 75 million Indian diabetics.

“Diabetes unfortunately is the price you pay for progress,” said Dr. A. Ramachandran, the managing director of the M.V. Hospital for Diabetes in Madras.

For decades, Type 2 diabetes has been the “rich man’s burden,” a problem for industrialized countries to solve. But as the sugar disease, as it is often called, has penetrated the United States and other developed nations, it has also trespassed deep into the far more populous developing world.

In Italy or Germany or Japan, diabetes is on the rise. In Bahrain and Cambodia and Mexico – where industrialization and Western food habits have taken hold – it is rising even faster. For the world has now reached the point, according to the United Nations, where more people are overweight than undernourished.

Diabetes does not convey the ghastly despair of AIDS or other killers. But more people worldwide now die from chronic diseases like diabetes than from communicable diseases. And the World Health Organization expects that of the more than 350 million diabetics projected in 2025, three-fourths will inhabit the third world.

“I’m concerned for virtually every country where there’s modernization going on, because of the diabetes that follows,” said Dr. Paul Zimmet, the director of the International Diabetes Institute in Melbourne, Australia. “I’m fearful of the resources ever being available to address it.”

India and China are already home to more diabetics than any other country. Prevalence among adults in India is estimated about 6 percent, two-thirds of that in the United States, but the illness is traveling faster, particularly in the country’s large cities.

Throughout the world, Type 2 diabetes, once predominantly a disease of the old, has been striking younger people.

But because Indians have such a pronounced genetic vulnerability to the disease, they tend to contract it 10 years earlier than people in developed countries. It is because India is so youthful – half the population is under 25 – that the future of diabetes here is so chilling.

In this boiling city of 5 million perched on the Bay of Bengal, amid the bleating horns of the auto-rickshaws and the shriveled mendicants peddling combs on the dust-beaten streets, diabetes can be found everywhere.

The conventional way to see India is to inspect the want – the want for food, the want for money, the want for life. The 300 million who struggle below the poverty line. The debt-crippled farmers who kill themselves. The millions of children with too little to eat.

But there is another way to see it: Through its newfound excesses and expanding middle and upper classes. In a changing India, it seems to go this way: Make good money and get cars, get houses, get servants, get meals out, get diabetes.

In perverse fashion, obesity and diabetes stand almost as joint totems of success.

Last year, for instance, the MW fast- food and ice cream restaurant in this city proclaimed a special promotion: “Overweight? Congratulations.”

The limited-time deal afforded diners savings equal to 50 percent of their weight in kilograms. The heaviest arrival lugged in 135 kilograms, or 297 pounds, and ate lustily at 67.5 percent off.

Too much food has pernicious implications for a people with a genetic susceptibility to diabetes, possibly the byproduct of ancestral genes developed to hoard fat during cycles of feast and famine. This vulnerability was first spotted decades ago when immigrant Indians settled in Western countries and in their retrofitted lifestyles got diabetes at levels dwarfing those in India.

Now westernization has come to India and is bringing the disease home.

Though 70 percent of the population remains rural, Indians are steadily forsaking paddy fields for a city lifestyle that entails less movement, more fattening foods and higher stress – a toxic brew for diabetes.

In Madras, about 16 percent of adults are thought to have the disease, one of India’s highest concentrations, more than the soaring levels in New York, and triple the rate two decades ago. Three local hospitals, quaintly known as the sugar hospitals, are devoted to the illness.

The traditional Indian diet can itself be generous with calories.

But urban residents switch from ragi and fresh vegetables to fried fast food and processed goods. The pungent aromas of quick-food emporiums waft everywhere here: Sowbakiya Fast Food, Nic-Nac Fast Food and Pizza Hut. Coke and Pepsi are pervasive, but rarely their diet versions.

The country boasts a ravenous sweet tooth, hence the ubiquitous sweet shops, where customers eagerly lap up laddu and badam pista rolls. Sweets are obligatory at social occasions – birthdays, office parties, mourning observances for the dead – and during any visit to someone’s home, a signal of how welcome the visitors are and that God is present.

“When you come to the office after getting a haircut, people say, ‘So where are the sweets?'” said Dr. N. Murugesan, the project director at the M.V. Hospital for Diabetes.

The sovereignty of sweets can pose ticklish choices for a doctor.

Trying to set an example, Dr. V. Mohan, chairman of the Diabetes Specialities Centre, a local hospital, said he had omitted sweets at a business affair he arranged, and nearly incited a riot.

Last year, his daughter was married. Lesson learned, he laid out a spread of regular sweets on one side of the hall and on the other stationed a table laden with sugar-free treats. Everyone left smiling.

In the United States, an inverse correlation persists between income and diabetes. Since fattening food is cheap, the poor become heavier than the rich, and they exercise less and receive inferior health care. In India, the disease tends to directly track income.

“Jokingly in talks, I say you haven’t made it in society until you get a touch of diabetes,” Mohan said. He points out that people who once balanced water jugs and construction material on their heads now carry nothing heavier than a cellphone. At a four-star restaurant, it is not unusual to see a patron yank out his kit and give himself an insulin injection.

The very wealthy have begun to recoil at ballooning waistlines, and there has been a rise in slimming centers and stomach-shrinking operations. In high- end stores, one can find a CD, “Music for Diabetes,” with raga selections chosen to dampen stress.

The rest of urban India, however, sits and eats.

In Madras, workers in the software industry rank among the envied elite. Doctors worry about their habits – tapping keys for exercise, ingesting junk food at the computer. Dr. C.R. Anand Moses, a local diabetologist, sees a steady parade of eager software professionals, devoured by diabetes.

“They work impossible hours sitting still,” he said.

S. Venkatesh, 28, a thick-around-the- middle programmer, knows the diabetes narrative. Much of his work is for Western companies that operate during the Indian night. So he works in the dark, sleeps in the day.

“The software industry is full of pressure, because you are paid well,” he said. “In India, if you work in software, your hours are the office.”

His sole exercise is to sometimes climb the stairs. A year and a half ago, he found out he had diabetes.

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~ by badkow on October 3, 2006.

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