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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 specialistslooking 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.
No one would choose to live with this time bomb, but millions must. What's heartening is that they can live with diabetes if they manage it carefullyeating healthily, exercising and minimizing stress. Japanese singer Hideo Murata chose not to take control, refusing treatment even though he knew he was diabetic. He had a heart attack in 1995, lost both legs and died last June.
Few have done so as successfully as Wasim Akram. His first hint that something was amiss came in 1997 when he found himself rapidly losing weight. He felt weak and tired, craved desserts and kept waking at night to urinate. A doctor in Lahore diagnosed him with Type 1 diabetes and told him to go on insulin at once. "I was very down," says Akram. "I had heard diabetes only happened to obese people. I'm not fat." Indeed, at the time, Akram was a world-class athlete, a man of 30 and at the height of his career as a fast bowler for Pakistan's national cricket team.