Wealth fuels India's rise in diabetes

A nation's economic boom lifts millions out of poverty, but prosperity brings western food habits, sedentary lifestyles and health disorders.

Patient in a wheel chair at Dr Mohan's Diabetes Specialties Centre in Gopalapuram, Chennai, India.

CHENNAI, INDIA // T Selvaraj lies writhing in pain on a hospital bed in an overcrowded ward. A neuropathic ulcer in his left leg is giving Mr Selvaraj sleepless nights. "It is excruciatingly painful," he says, as he gingerly pulls out a syringe and injects it into a wad of subcutaneous fat above his naval. At 29, the ulcer threatens to rob Mr Selvaraj of a leg. Every 30 seconds, somewhere in the world, someone like Mr Selvaraj loses a leg - not to land mines, but to diabetes. Some 3.8m people died last year due to diabetes, according to the World Health Organization. That is more than the number killed by Aids and nearly four times the deaths from malaria.

Earlier believed to be the "rich man's disease", blighting mainly the developed world, diabetes is now slowly, yet inexorably, engulfing much of the developing world. Eighty per cent of people with diabetes now live in developing countries, where, the WHO predicts, the number of diabetics will increase one-and-a-half times in the next 25 years. India has the largest number of diabetics in the world - nearly 35m, which is nearly 15 per cent of the global total. India has now come to be known as the "diabetes capital of the world".

Once known for famines, India in recent years has experienced a torrid economic boom that lifted millions out of poverty. But with this new-found prosperity has come a slew of lifestyle disorders, diabetes being the most lethal. Amid the rising incomes from plush call centres and software parks, western food habits and sedentary lifestyles are taking root among India's burgeoning middle class. Obesity is on the rise, and carrying a big belly has become a totem of success, propelling a deadly upsurge in diabetes, experts said.

"In a land where famines once made people starve, a bulging paunch is mistaken for affluence," said V Mohan, who runs a diabetes specialties centre in Chennai. "Indians today suffer from what I call 'affluenza' - too much consumption." Type 2 diabetes - a disease of high blood sugar brought on by an unhealthy lifestyle involving fattening foods and a lack of physical exercise - constitutes more than 90 per cent of all diabetes cases in developing countries, according to experts. It often results in amputations, blindness and heart failure.

Lying on his hospital bed, a sharp pain causes Mr Selvaraj's leg to shudder. His leg ulcer - which might lead to an amputation - is also a consequence of type 2 diabetes. He dreads losing a limb. "How will I ever work without a leg?" he sighs, as he gives himself the insulin injection. Seven years ago, Mr Selvaraj left his father's arid farm in Cuddulore in rural Tamil Nadu to open a grocery shop in Chennai. As his economic situation improved, he indulged heavily in alcohol and rich, oily food. With his new business, he earned money and contracted diabetes.

Mr Selvaraj's condition is indicative of how diabetes is increasingly affecting the young, and with India urbanising rapidly, diabetes - believed largely to be an urban malaise - is quickly spreading to vast swathes of rural India. Worldwide, nearly 70 per cent of all leg amputations are linked to diabetes. Experts warn that the brisk spread of diabetes in India could have a devastating effect on its economy. Diabetes alone accounts for US$2.2 billion (Dh8bn) in annual health care costs in India.

A recent report from the Indian Council of Research on International Economic Relations estimates the loss to India's national income as a result of heart disease, stroke and diabetes in 2005 was $9bn and projects that figure will exceed $237bn over the next 10 years. According to the WHO, 80 per cent of people in developing countries pay directly for some or all of their own medicine. And developing countries are dominated by the relatively high costs of insulin and oral hypoglycaemic drugs.

The good news, however, said Akash Kapur, the managing director of the Denmark-based World Diabetes Foundation, is that much of the projected increase in diabetes is preventable, through attention to diet and physical activity. Treatment costs escalate only if diabetes is not recognised at a later stage or improperly treated. "My contention is that treatment of diabetes is not expensive. Not preventing and not treating it well is very expensive," he said. "It takes just $3 to educate a person with diabetes to take care of his feet; it takes over $450 to treat a non-healing wound in the foot because of ignorance about how to care for your feet if you have diabetes. Tell me then what is expensive and what is not?"

A recent study in Chennai - a manufacturing and software hub in southern India, where nearly 20 per cent of adults are thought to have diabetes, one of India's highest concentrations - found that awareness of diabetes as a public health priority and knowledge of diabetes prevention is poor, especially among women and people with little education. Progress is impeded, experts say, by a health system that places a higher priority on communicable diseases. The Indian government spends close to 1.2 per cent of its annual budget on health, with the vast majority on communicable disease prevention.

India's ministry of health spearheaded a national consultation in 2005 to identify action pathways and partnerships for implementing a strategy for diabetes in India. And in January this year, it launched the pilot phase of a programme it called the "National Programme on Diabetes, Cardiovascular diseases, and Stroke (NPCDS)" in seven states across India, a program designed to increase awareness about the disease.

With the growing prevalence rate of diabetes among India's 1.1bn strong population, V Mohan thinks this is not nearly enough. Change, he says, can only come when mindsets change. He recently motivated a community in Chennai to construct a public park with its own funds, without being dependent on the local government. Often, his diabetes speciality centre spearheads camps in cities and villages in southern India to spread the word about diabetes, heart disease and preventive health care.

"The message I try give out is that 'Fatness is not wellness,'" he said. "It'll take a while before that mindset changes." * The National