Diabetes On The Move

Tuesday, Jun. 06, 2006 By ALICE PARK

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On the fifth floor of a fading pink-and-green building in New Delhi, Dr. Ashok Jhingan is waging a desperate battle against a relentless medical foe. In an office that's only a few degrees cooler than the sweltering city outside, Jhingan and his small team of doctors are tackling what could be India's biggest emerging health problem. No, it's not aids or cholera or malaria, each of which is tragically entrenched among the country's 1 billion people.

Instead it's that scourge of better-fed nations—Type 2 diabetes—which may prove just as deadly for coming generations. Every day, 50 to 60 patients file through Jhingan's two clinics in New Delhi; nine of them will find out for the first time that they have the disease. Deceptively nonthreatening at first, diabetes can lead to heart disease , amputations, blindness, kidney failure and other complications if not properly treated.

The trend is the same in Cambodia, China, parts of Africa and many island nations in the Pacific. What alarms public-health experts most is the speed with which diabetes has reached epidemic levels in these regions—and the fact that it is affecting children as well as adults. In 2000, 151 million people around the world had diabetes; by 2025, that number could double. Over the past two decades, the prevalence of the disease in China has jumped from 0.5% to 5%, while in cities in India, it has gone from 8% of adults in 1989 to an estimated 15% today.

What's driving the upswells? A rising standard of living and greater exposure to a Western diet rich in sugars and empty calories are certainly to blame, along with a more sedentary lifestyle. But many patients turning up at Jhingan's office and similar clinics are not fat—at least not by Western standards. It appears that a change in diet and a few extra pounds are enough to trigger the disease in many Asian and African populations.

The tendency for even modest weight gains to trigger diabetes is most likely the genetic legacy from ancestors who had to cope with cruel cycles of feast and famine. Under such conditions, survival favored those genetically blessed with a highly efficient ability to squirrel away calories during times of plenty by breaking food down into glucose, then storing it as fat. Now surrounded by a constant source of food and living a less active lifestyle, people born with that genetic pedigree are perfectly primed for diabetes. "It's not simply that Western food is causing diabetes but that different body types, influenced by genes, respond to the same food differently," says Dr. William Hsu of the Joslin Diabetes Center. With no famine, these genes continue to convert food into glucose and fat. Excess glucose levels build up gradually in the blood, and insulin, which normally keeps glucose levels in check, can't keep up. After years of this metabolic treadmill, diabetes can develop.

The entire phenomenon might even be working on a more telescoped time frame. Some scientists have suggested that the womb of a mother who is malnourished during pregnancy may simulate "famine-like" conditions for the fetus. That may "predispose the baby to hoard nutrients," explains Paul Zimmet, professor of diabetes at Monash University. "Those changes persist in adult life and are reflected in obesity or diabetes."

Because the disease may look different in patients in the developing world, diagnostic red flags like obesity, so useful in the U.S., may not be right for patients elsewhere; treatment may also vary. The International Diabetes Federation, which works with the World Health Organization to promote diabetes education, is proposing a new set of guidelines that would set specific criteria for detecting diabetes in different populations.

Despite the sobering statistics, doctors believe that this is one epidemic that could be controlled and at a low cost. Recent studies in the U.S., Finland and China showed that many of those at risk of developing diabetes can bring their blood sugar down to normal levels without medication, by changing their diet and becoming more physically active. In the U.S. trial, patients who made these changes reduced their risk of developing diabetes nearly 60%. Hopefully the rest of the world won't just pick up our bad habits but learn from our good examples as well.

-With reporting by Benjamin Siegel/New Delhi and Susan Jakes/Beijing