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, Ms. 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 Chennai (formerly 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 five million perched on the Bay of Bengal, amid the bleating horns of the autorickshaws and the shriveled mendicants peddling combs on the dust-beaten streets, diabetes can be found everywhere.
A Noxious Sign of Success
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........ more at the link