Watch out, you may be next India has 50 million diabetics and millions more in the pre-diabetic stage. T.V. Jayan sounds the alarm bells on the pre-diabetes wave that is about to engulf India It’s just a sandwich, you told yourself, as you bit into t

Watch out, you may be next

India has 50 million diabetics and millions more in the pre-diabetic stage. T.V. Jayan sounds the alarm bells on the pre-diabetes wave that is about to engulf India

It's just a sandwich, you told yourself, as you bit into the mayo-smothered chicken nestling between two slices of soft white bread. You watched your spreading waistline in the mirror — and promised yourself that one of these days you'd do something about it. And when the doctor told you to go join a gym, you yawned. There would be time enough for all this, you said. It's a story that may sound familiar to Chennai resident Sangeetha Raju. She's been there, done that — but wishes she hadn't. Last year, the 42-year-old banker had the chance of making an investment of her lifetime. She could have cut Rs 1,000-4,000 from her monthly expenses and saved herself some heartache. Raju was what doctors call a pre-diabetic — that is, her blood sugar level was above the normal, but not as high as that of a diabetic. Today she is a full-blown diabetic, requiring life-long medication — only because she ignored her doctors' advice. All she had to do was exercise for 30 minutes every day. But Raju thought pre-diabetic wasn't the same as a diabetic. Millions of people across India are making this mistake. A burgeoning population of young and middle-aged people has been diagnosed with borderline diabetes, a transition stage before full-blown diabetes, warns V. Mohan, head of Dr Mohan's Diabetes Specialities Centre, Chennai. People like you and me could be among them — the disease cuts across age, region, gender and class. Doctors warn that pre-diabetes is affecting not just those who have diabetes in their genes but even people with no such family history. Dropping levels of physical activity and wayward eating habits have together caused a diabetic epidemic in the country. And propping up this mountain are people like Raju, who could have walked away from the disease — but didn't. Geetanjali Shah, a 35-year-old Delhi psychologist, did that. A pre-diabetic, she was asked to reduce her weight by one-third to ward off the progression to diabetes. She ended up losing 30kg in five months. "She strictly followed 400 minutes of intensive physical activity per week, along with a strict diet," says her physician, Dr Anoop Misra, an internal medicine specialist at the Fortis Hospital in New Delhi. "Her pre-diabetes reversed to normal blood glucose levels." Her cholesterol and blood pressure levels — which used to be high before she started exercising — also became normal. If left unattended, pre-diabetic people run a high risk of developing diabetes within the next 5-10 years. That, in turn, can cause a host of ailments — including heart problems, kidney failure, damaged eyesight, erectile dysfunction and ulcers that can lead to amputation. The problem, doctors stress, is that few take borderline diabetes as a serious warning. "But the high prevalence of pre-diabetes may be a predictor of ominous things to come," says Nihal Thomas, an endocrinologist at Christian Medical College, Vellore. It may lead to a spurt in diabetes in less than a decade from now, he says. The actual number of pre-diabetics in the country is not known, but it is roughly 25-40 million — a huge worry for a country which already has more than 50 million diabetics. The latest Diabetes Atlas, released last year by the Brussels-based International Diabetes Federation, says that India will have 50.8 million diabetics in 2010. By 2030, the numbers will rise to 87 million. Borderline diabetes crops up in two forms — as impaired fasting glycaemia (IFG) and impaired glucose tolerance (IGT). In the first case, fasting blood sugar levels would be 100-126 milligram (mg) per decilitre (dl), whereas a healthy person's levels would be 70-100mg/dl. Those who suffer from IGT will have higher than normal sugar levels in the blood after a meal, though the levels wouldn't be as high as those with diabetics. Both indicate defects in the action or secretion of the hormone insulin whose primary job is to goad the cells in the liver, muscles and other organs to take up sugar in the bloodstream and use it as an energy source. The failure to do so means extra sugar in the blood, which translates into diabetes, a disease that often slowly kills. Of course, diabetes is often also genetic. If a person's parents are — or one of them is — diabetic, he or she is likely to become diabetic. But diabetes will probably come with the alarm bells — in the form of pre-diabetes. It is at this stage that people can make or break their future. For the disease can actually be checked in the pre-diabetes stage — and some believe it's the only way of battling the mounting diabetic epidemic in the country. What's interesting is that it's not difficult to do so. Many studies have shown that weight reduction through lifestyle modification and physical activity can reduce the risk of diabetes among the pre-diabetic population by half. "A mere 7 per cent weight reduction is all that is needed to cut the risk of diabetes by 58 per cent," says Mohan, quoting a landmark study by an international team which followed up 2,700 patients over up to 10 years and which appeared in the Lancet journal last October. Mohan's clinic has, interestingly, developed a simple scoring system called Indian Diabetes Risk Score, for those who have never had to undergo any blood sugar test. The do-it-yourself system, based on your age, waist circumference, physical activity and family history, tells you whether you are at risk or not (see box below). Losing weight and exercise help even those with a family history of diabetes. It's just that they have to work harder, says Misra. "Sometimes diabetes manifests even after taking all of these precautions. However, in most cases, it is delayed," he says. But pre-diabetics cannot wait and watch — as many tend to, to their own detriment — because the growing number of diabetics in the country is a cause for concern. The World Health Organization estimates that the economic burden of diabetes, heart diseases and stroke comes to about $210 billion in 2005. In India, people spend 2.5-15 per cent of their health budget on diabetes treatment alone. Thomas believes that nearly 10 per cent of India's adult population is pre-diabetic. The 2001 National Urban Diabetes Survey which covered six metros found that Hyderabad had the highest pre-diabetes prevalence at 29.8 per cent, followed by Chennai with 16.8 per cent, and Bangalore, 14.9 per cent. The study put the borderline diabetes prevalence in Calcutta at 10 per cent. Random studies in Bengal have shown that the prevalence of the most common form of diabetes in the state has gone up to 10-12 per cent versus 8 per cent about five years ago, says Ashok Kumar Jain, chief diabetologist at the S.K. Diabetes Research and Education Centre in Calcutta. Kerala — with a 19 per cent diabetic population, possibly the highest in the country —may also have the highest prevalence of pre-diabetes in the country. Mobile clinics conducted by Kesavadas Jothydev, who runs a diabetes research centre in Thiruvananthapuram, in Kerala have thrown up a scary picture. Up to 26 per cent of people in the 25-35 age group and 40 per cent in the 50-60 age group are pre-diabetic, he says. Public health experts are also worried that the scourge — once seen as a disease of the urban rich — is spreading to rural areas too. A recent study showed that 18 per cent of those below 30 years in urban areas of Vellore were pre-diabetic, as opposed to 14 per cent in the rural areas. A study in the Godavari region of Andhra Pradesh has shown that 14 per cent of its predominantly agrarian population is pre-diabetic, in addition to 13 per cent who already suffer from diabetes. The mechanisation of farm work — which means less manual work — is one of the reasons for the spread of the disease in rural India. Obesity is also one of the main factors responsible for pre-diabetes and diabetes. The Third National Family Health Survey conducted in 2006 shows that obesity has reached alarming levels in many states. Another study states that about 20 per cent of Indian school children are obese. And many of them, clearly, are going to be pre-diabetics sooner rather than later. When it comes to obesity, the odds are already stacked against Indians. Studies have shown that people in the sub-continent put on more fat around their abdomen than those in the West. The increased body fat leads to greater insulin resistance in Indians, says Dr Seema Gulati, dietician at the Diabetes Foundation of India. Clearly, Indians have to strive that much harder to ward off diabetes. And they'd better swallow the bitter pill — without a sweet coating.

http://www.telegraphindia.com/1100221/jsp/7days/story_12131340.jsp
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The small car with a very long story

After running on Indian roads for over 25 years, the Maruti 800 is being withdrawn. But when it was launched, it evoked enormous public interest. This extract from a new book by R.C. Bhargava and Seetha recalls the excitement over the car

When Maruti Udyog was established, the site on which the by-now defunct factory that Sanjay Gandhi had built was overrun with weeds. When . Suzuki first visited the factory, he was startled to find that the place was swarming with monkeys. Tongue firmly in cheek, I (Maruti chairman R.C. Bhargava) told him that the monkeys were there because Maruti was another name for Hanuman, the mythological monkey god, and the faithful servant of the god Rama! I explained to him that it would not be possible to kill or hurt the monkeys. They would go away on their own at the appropriate time. And this is exactly what happened. Hanuman was a son of the wind god and, though it is not clear if Sanjay Gandhi had this in mind when giving the name Maruti to his company, the name turned out to be appropriate for a 630kg car that was to signify lightness and speed, in contrast to the ponderous, slow image of the 900kg Ambassador and the 700kg Premier Padmini. *** At a press conference in Kolkata, sceptical journalists mocked that the Maruti 800 would disappear in the city's famed potholes during the rains! The following year, after the monsoons, at another press conference in Kolkata, I asked them what happened to the car. The journalists admitted that the Maruti 800 was the only car which could keep running even when the roads were flooded. They wanted to know why. The reason, I explained, was that the distributor in SMC vehicles was waterproof, whereas in the Ambassador and Premier Padmini water splashing from the road would enter the distributor and bring the car to a stop. *** The interest from the public was enormous. This was the first time after several decades that people had seen any vehicle different from the Ambassador and the Premier Padmini. The finish and the paint quality were vastly superior to those vehicles, as were the fuel consumption and other performance data. A few of the cars imported for the roadshow, not required by the engineering department and for vendor-component testing, were allotted for use by senior officers of Maruti. They evoked a lot of interest on the road. At every traffic light halt, people would stare and often come up to whoever was driving and ask questions about the car and when it was to hit the market. When V.K. Mathur, who had joined from the government as the general manager for projects, was driving one of these cars, he found awestruck occupants of a Mercedes staring and pointing at the car. N.D. Tiwari's first question on seeing the car, when D.V. Kapur (secretary, heavy industry) took it to Udyog Bhavan, was, 'Where will you put the holdall?' The holdall carried the bedding and was in those days an intrinsic part of all travel, whether by road or train. He was shown the boot at the rear, but he felt it was too small. He suggested that provision be made for a luggage carrier atop the car, as was the case with other Indian cars. Maruti did develop a luggage carrier suitable for the car, but it never became popular. People started travelling without carrying their bedding! As the start up deadline neared, pressure increased on every one. One October day in the factory, Krishnamurthy and I handed out promotion letters, one of them to Amitava Nandy (who was in charge of projects). Half an hour later, feeling on top of the world, Nandy encountered Krishnamurthy in the corridor. Krishnamurthy took him to a corner and said, 'Your project is delayed. If you feel you can't do it, hand over your resignation letter and I will relieve you immediately.' The assembly of cars was behind schedule because the testing line, on which cars are tested after they came off the conveyer belt, was getting delayed for want of a good electrician. Nandy knew that apart from the why of a problem, we also wanted to know how it could it solved. More than that, we just wanted it solved. Nandy then went to Gurgaon town, found five electricians and tested them at the factory. He found one whose work was satisfactory and he was put on the job, with Anzen Electricals, the electrical contractor, helping him out. The man later became Maruti's main electrical contractor. The assembly line was completed and on 19 November, the first car to be assembled on the line rolled out. It was Indira Gandhi's birthday, a fact Krishnamurthy made sure to mention when she came to launch the first cars on 14 December 1983. Before the assembly of cars could start, Maruti's employees understood what Japanese work culture really meant. A. Shinohara, who was the director production, would not allow the assembly line to start unless all the equipment and the shop floor were absolutely clean. A lot of dirt had accumulated during the process of erecting the equipment. Initially Maruti employees thought that sweepers would do the cleaning. But in Japan there are no sweepers and everyone does his own cleaning. Shinohara picked up a broom and a bucket of water and started cleaning the shop floor! Maruti employees could hardly refuse to do the same. For the next ten days the cleaning work continued, with Shinohara as the leader. Assembly operations started when he was fully satisfied. He explained to all that the first requirement for quality work is absolute cleanliness and each person must keep his work area clean. The same principle was extended to the offices. The lesson was well learnt and when V. Krishnamurthy (then chairman of Maruti) or I saw a nut or a piece of paper on the shop floor, we would pick it up. With cleanliness in mind, designated areas were provided where tea and snacks were served. No food could be taken outside these areas. Of course, smoking was a big no-no inside the factory. Nobody was even allowed to bring in a matchbox because of the many highly inflammable materials inside a car factory. With the message going out loud and clear that no delays or sloppiness would be tolerated, there was little evidence of slackness. The sacrosanct deadline was finally met. On 14 December 1983, Sanjay Gandhi's birth anniversary, Mrs Gandhi formally inaugurated the factory. It was the first time she was stepping into the factory; she had seen it from outside just once. In a voice choked with emotion, she said: 'This small car has a very long story.' She went on to describe Sanjay's dream of building small cars and all the efforts he made and hardships he endured in trying to make his dream a reality. She pressed the button that started the assembly line and the first car for sale rolled out. She personally gave the keys to the first 10 allottees of cars from all over India, the first being Harpal Singh of Indian Airlines.

Extracted from The Maruti Story: How a public sector company put India on wheels, by R.C. Bhargava with Seetha; Published by Collins Business (an imprint of HarperCollins Publishers); Pp 383; Price Rs 499

Palash Biswas
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