Silent Killer

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As a result, the disease shows up in Asian cities far more than in the countryside. For example, Thailand has a relatively low rate of diabetes nationwide—4.8%—but that figure jumps to almost 7% in the nation's cities. One of these sufferers is Lumpoon Narinook, 55, who grew up working alongside her parents on their small farm in northern Thailand. Farming or playing, she was almost constantly active. She moved to Bangkok when she was 25 to find work, settling in a one-room concrete apartment in the Klong Toey slums, and her life slowed down. She became a street vendor, making and selling sweets. Her weight rose, and she began having spells of blurred vision. Thirteen years ago, Narinook was diagnosed with Type 2 diabetes. She had never heard of the disease, and even now she asks if anyone outside Thailand has it. Regular insulin shots have helped stabilize her condition, but one of her five children is diabetic, and she worries about her grandchildren and nieces and nephews, urging them to exercise and stay away from fast food. She's afraid to send them to the nearby playground, however, because she fears they might get robbed or even snatched.

In Bangkok's low-income neighborhoods as many as 20% of the residents are thought to have impaired glucose tolerance, a high-blood-sugar condition that often leads to diabetes. As Bangkok goes, so do other fast-changing, migrant-packed cities in Asia. Only 1.2% of Jakarta's population was diabetic in 1990; in 2000, the figure hit 12%. In Vietnam, less than 5% of people in major urban areas have diabetes, which sounds small but represents a threefold increase in the past decade. And this is only the beginning. According to a 2002 report by the IDF, "the prevalence of adult diabetes in developing countries is expected to increase by 170% between 1995 and 2025" versus 41% in the developed world. To Dr. Warren Lee of KK Women's and Children's Hospital in Singapore, it's all part of a seismic shift away from the more physical lifestyle of our hunter-gatherer ancestors: "Twenty-first-century man is becoming a sedentary person because of the nature of his work."

What to do in a vast continent growing ever more populous, comfortable on the couch, trapped in the embrace of office cubicles and behind fast-food trays? Singapore, that model of social engineering, has come up with a plan. Back in the 1980s and 1990s, the country went through a period of "epidemiological transition," says Dr. Chew Suok Kai, director of the Ministry of Health's epidemiology and disease-control division. In other words, obesity rates shot up, as did the prevalence of diabetes. A study released in September by KK Women's and Children's Hospital showed that 15% of Singaporean adults have diabetes. Among children in general, the rate is low. But it stands at 36% for obese kids.

Unlike most of Asia, however, Singapore has the resources and will to tackle the disease. Several hospitals have departments that specifically treat the disease, and kids are carefully observed at schools: those identified as overweight are placed in special exercise classes. During morning rush hour, streams of uniformed, overweight children jog along the orchid-lined boulevards. Officials dreamed up a $100 million bond offering to fund a program that promotes healthy living. They've even bullied street vendors into hawking fare made with less oil and are trying to exert the same moral suasion on fast-food joints. The goal, says Chew, is to get the rates below 10% by 2010. He's hopeful; the city-state's incidence rates for diabetes are actually slowing.

Few countries are this proactive. "Let's face it," says Professor Sunthorn Tandhanand, president of the Diabetes Association of Thailand, "our government is already trying to make ends meet, and there are a lot of more-serious diseases out there that need more-immediate attention." (Thailand's list of diseases is pretty much the same as the rest of Asia's, from AIDS to tuberculosis.) Indonesia has 50 diabetes specialists—looking after 6 million patients. In Japan, the bill for treating diabetes is $8 billion, according to the government. But Dr. Shunya Ikeda of the Keio University School of Medicine says the bill is far higher if you include the cost of treating the disease's complications.

And money is just one of the obstacles in the war against diabetes. Cultural factors get in the way, too. Dr. Huen Kwai Fun of Tseung Kwan O Hospital in Hong Kong says she still meets parents who are ashamed when they learn their children have diabetes, and she says children with the disease are sometimes ostracized on the playground or in the neighborhood. For Elayaperumal, father of Arun and Elakkiya, his daughter's diabetes opened a new range of concerns. "We are keeping our fingers crossed and praying that the girl should not lose her eyesight," says her father. "But we are also worried about how we can get her married." Dr. Shobana Ramachandran, assistant director of the M.V. Hospital for Diabetes in Chennai, recalls a young bride who didn't take insulin during her honeymoon because she had kept her diabetes a secret during courtship. The disease does not permit for such lapses: the newlywed fell into a coma and died.

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