[Nasional-e] Silent Killer

Ambon nasional-e@polarhome.com
Mon Dec 9 00:00:30 2002


Silent Killer

 Diabetes is becoming an asian epidemic, and its victims are younger than
ever. What's behind the crisis?

By Phil Zabriskie Hong Kong

Troubled Future: Arun went blind at age 12. His sister Elakkiya may face a
similar fate

Earlier this year, Chan Tak "Anson" Shin developed a rash on his leg that
wouldn't heal. Not overly concerned, he visited a doctor near his home in
Hong Kong's New Territories and underwent a string of blood tests. The
diagnosis? Type 2 diabetes, long known as "adult-onset diabetes."
Genetically speaking, Anson was an ideal candidate for the disease. Both his
grandfathers had suffered from it in their later years, as did his father
and two uncles. And, by his own admission, Anson led a less than healthy
lifestyle, spending most of his spare time playing a computer game called
Heroes of the Three Kingdoms. He loved to eat too. He'd scarf down bags of
potato chips at a sitting, and he dined at McDonald's and Pizza Hut several
times a week. But in another sense, Anson was a shockingly unlikely victim
of adult-onset diabetes. He was, after all, just a kid—a regular, somewhat
plump 13-year-old boy.

Diabetes isn't behaving the way it did in the past. Forget your former
notions of the disease: that it strikes old aunties and the rich, or that it
seldom kills. Diabetes no longer cares about class distinctions or age—it's
becoming as prevalent in Asian slums as in mansions, and it's ravaging the
young like never before. The numbers are staggering. The World Health
Organization (WHO) estimates that 177 million people worldwide have
diabetes, a figure that's expected to surpass 300 million by 2025. Dr. Paul
Zimmet, director of the International Diabetes Institute (IDI) in Victoria,
Australia, predicts that diabetes "is going to be the biggest epidemic in
human history." It has also increasingly become an Asian disease. Today,
some 89 million Asians are thought to be diabetic, and four of the five
largest diabetic populations are to be found in Asian countries. India has
an estimated 32.7 million people with diabetes, according to the IDI. China
has 22.6 million, Pakistan 8.8 and Japan 7.1.

The disease is also spreading more rapidly in Asia than anywhere else.
Asia's count is expected to hit 170 million by 2025, with India and China
together accounting for almost 100 million victims. Most of Asia is
hopelessly unprepared for this health crisis, which will inundate hospitals
and place increasing pressure on national healthcare budgets. But the toll
of this disease is ultimately more personal and painful than these numbers
can convey. You may susceptible yourself—your kids, too.

Diabetes attacks the body slowly and stealthily, leading to a common
misconception that it's a relatively benign condition. Initially, it
produces only subtle symptoms such as excessive thirst and frequent
urination, so the patient is often unaware that anything is wrong. "Half the
people with diabetes don't know they've got it," says Zimmet. "It's a silent

In a healthy body, the pancreas releases the hormone insulin, which
transforms blood sugar into energy. Diabetes interrupts the process.
Untreated or unrecognized, the disease causes excess blood sugar to build in
the veins. It gradually clogs blood vessels, damages body tissue, wrecks the
eyes, the kidneys, the heart. This invites a host of miserable fates:
strokes, heart disease, high blood pressure, kidney failure, blindness,
amputations due to the loss of circulation. "Mortality statistics seriously
underestimate its impact," says Dr. Hilary King, director of the WHO's
diabetes unit, "since most people with diabetes die from its consequences
rather than the disease itself."

There are two varieties of diabetes. Type 1—insulin-dependent diabetes—is an
inherited autoimmune affliction wherein the pancreas doesn't produce
insulin. In the old days, children who were forced to inject themselves with
insulin before school each day were nearly all in this group: they were born
with the disease, and they will die from it if they do not take insulin
regularly. Arun Elayaperu-mal, a 16-year-old from Chennai, India, was
diagnosed as Type 1 when he was barely three, though his family apparently
had no prior history of the disease. "My wife and I were completely
shattered," says Arun's father, Elayaperumal, who works at a zoo on the
city's outskirts. The family couldn't afford insulin, but a local hospital
gave it to Arun for free. Even so, his vision began to fail, and he went
blind at 12. "I still remember climbing trees and playing cricket, and the
colors of the animals," says Arun. He has thrived in a special school for
blind and deaf children and now hopes to be a teacher. But his family was
jolted anew when his sister, Elakkiya, was also diagnosed with Type 1. She
was only two-and-a-half years old.