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Type 2 is the strain most of us have to fear. This is the real epidemic, accounting for 90-95% of diabetes cases worldwide. In this form, the pancreas isn't the problem. It does its job of producing insulin, but for some reason scientists haven't been able to fathom, it either doesn't produce enough or the body fails to employ the insulin as it should. The effect can be devastating.
A decade ago, a case like Anson's would have been startlingly rare. No longer. Type 1 is still the most common form of the disease in children, but experts believe the opposite could be true in the next 10 to 20 years. "There is an alarming shift downwards in the age of onset," says Professor Clive Cockram, vice president of the WHO-affiliated International Diabetes Federation (IDF). "These days, we're seeing far more patients who are under 40 and under 30," agrees Dr. Sum Chee Fang, director of the diabetes center at Singapore's Alexandra Hospital. Children are showing up in increasing numbers, too. In New Delhi, Yash Gupta was diagnosed with Type 2 at age 11 on a visit to the doctor for something so mild his mother can't remember what it was. In Japan, 80% of new cases in children are Type 2, some as young as nine. "We've even found a few Type 2 diabetics among kids below six," says Dr. Tsai Shih-tzer, president of the Taiwanese Association of Diabetes Educators.
The obvious question: What's speeding the sweep of Type 2 diabetes across Asia? Above all, it's a matter of lifestyle. The shape of Asia is literally changing, and many are inclined to blame it on Western-style food, personified by ubiquitous chains like McDonald's and KFC. Shigetaka Sugihara, a professor at Tokyo Women's Medical University, says simply that kids with Type 2 have "the Western type of diabetes." Likewise, Zimmet speaks of the "Coca-Colaization" and "Nintendoization" of Asia. Of course, fatty foods were popular in Asia long before globalization—from fried pork in the Philippines to dim sum in China. But as unhealthy foods become more widely available, it's no surprise to find kids eagerly devouring them, and washing them down with sugary drinks. It doesn't help that they also spend more time indoors than their forebears, seduced by TV or computers—much as their parents' generation has increasingly taken to driving instead of walking, and to typing memos instead of farming.
Evolution also comes into play. Researchers cite the theory of the "thrifty gene," which posits that the human body is designed to survive periods of feast and famine—the bountiful seasons of harvest and hunting followed by the inevitable fallow seasons. Food consumed in times of plenty is stored away for later use. Today, despite rampant poverty, there is more food available to the average person—a perpetual state of feast. The Worldwatch Institute in Washington, D.C., announced in 2000 that for the first time ever, there are as many overweight people on the planet as there are undernourished. Although the average Asian isn't nearly as large as the typical American couch potato, any excess fat can upset the regulation of blood sugar. Indeed, Zimmet uses the word "diabesity" to describe this phenomenon.
Anson, now 14, is a prime example. He isn't huge, but at 170 centimeters he already weighs 77 kilograms. That's clinically obese. And for Asians, the danger of being overweight appears to be greater: recent reports in 10 countries found that Asians are more likely to encounter the risks that come with obesity and diabetes than Westerners of identical height and weight. (Another conclusion of the studies was that Asians on the whole exercise less than Westerners.)
There is some evidence that certain ethnic groups—primarily Chinese, Indian and Malay—are more disposed to diabetes than others. They're especially at risk when they abandon traditional diets or lifestyles. Hence, abnormally high rates of Type 2 diabetes are found in the Chinese and Indian populations of, say, Mauritius. If a person moves from a village to a city, you would expect psychological consequences, such as homesickness and feelings of isolation. A similar process occurs inside the body. The changes trigger a kind of biological trauma that, among other things, upsets the processing of blood sugars and can lead to diabetes. The disease, explains Zimmet, is "spreading the way society is changing."