Page 90 - fbkCardioDiabetes_2017

66 Cardio Diabetes Medicine 2017

Childhood and Youth Onset Diabetes in

India: Profile, Changes, Progress & Future ?

Dr. Anju Virmani, MD, DNB (Endocrinology) (AIIMS)
Senior Consultant Endocrinologist,
Max, Pentamed & SL Jain Hospitals, Delhi

Abstract Childhood and youth onset diabetes in India:
Pediatric diabetes poses high medical, psychosocial Profile, challenges, progress and future?
and financial burden, especially in resource con- Diabetes is the second commonest chronic disorder
strained and remote environments where supplies of childhood, but is extremely demanding in terms
and specialized team members may not be avail- of medical, social and financial burden on the family
able. T1D remains the commonest diagnosis, but and the health care team. In recent years, however,
T2D and other types are increasing. Challenges are awareness of the disorder and management options
many. Correct diabetes education, which is crucial, have improved dramatically, making it easier for a
may not be imparted if medical and para-medical per- child with diabetes to become a healthy, productive
sonnel are themselves not aware. Insulin may not be adult.
available where needed, with storage and transport
at 2-8°C. Multidose regimens based on daily self glu- The complexity of management means that ideally
cose monitoring, most appropriate for age, finances, the team looking after these children should consist
intelligence and motivation of patient/ family, may of a pediatric diabetologist, nurse – educator, psy-
not be advised. Safe disposal of sharps may not be chologist, dietician, with several supporting special-
advised. Unnecessary dietary and other restrictions ties, with access not just to insulin, but the necessary
can interfere with compliance, growth, and physical technology for administering insulin (syringes, pens,
and emotional development. Adequate monitoring of pumps), tracking glycemia (glucostrips, continuous
A1C, growth and puberty, and for co-morbidities (eg glucose monitoring systems i.e. CGMS), and for mon-
hypothyroidism, celiac) and chronic complications, itoring for acute as well as chronic complications. In
and timely treatment, may not be done. Adequate the absence of a nation-wide registry, exact figures
financial and psychological support may be unavail- of incidence and prevalence cannot be given, but it
able. Poverty, illiteracy, and discrimination, in socializ- is estimated that presently India has about 70,000
[1]
ing, education, jobs and marriage, can further worsen children with diabetes . These numbers and their im-
health and quality of life. pact are set to rise for a number of reasons. Till a few
decades ago, even pediatricians would not suspect
The challenges can be met by patients, families, diabetes in a drowsy or comatose child, breathing
HCP, charitable organizations, and society at large, rapidly, or dehydrated yet passing urine, or with pain
working together, using awareness, support, and abdomen, etc. Death before diagnosis or soon after
technology. Significant progress has been made: im- diagnosis will decrease as awareness and medical
proved insulin delivery (syringes, pens, pumps) and facilities increase. All forms of diabetes are becoming
monitoring (glucometers, CGMS) devices; range of in- more common as obesity increases (and the signifi-
sulins and drugs; better lab support; freely available cant overlap between type 1 diabetes (T1D) and type
information on the internet; multiple self-help groups. 2 (T2D) can cause confusion). As survival improves,
Extensive research of different aspects is ongoing: the burden of chronic complications will rise, as will
T1D prevention, oral insulins, better devices, and islet social issues, including education, employment, mar-
cell and pancreatic transplantation. riage, discrimination, etc. Poverty, often associated
with illiteracy, poor nutrition, and poor access to

GCDC 2017