Last week, the Indian Council of Medical Research (IMCR) released guidelines for the diagnosis, treatment, and management of type 1 diabetes. This is the first time that the ICMR has issued guidelines specifically for type 1 diabetes, which is rarely more than type 2 – only 2% of all diabetic patients in the country with type 1 diabetes – but who are more frequent in recent years.
“Today more and more children are being diagnosed with type 1 diabetes in our country. This may be because the actual prevalence of the disease is rising in India. It may also indicate better awareness and as a result, an improved diagnosis of type 1 diabetes. Finally, children are more likely to survive due to early diagnosis and better treatment, ”the guidelines say.
India is considered the capital of diabetes in the world, and the epidemic has had an equal impact on those living with the disease. Type 1 diabetes or pediatric diabetes mellitus, is rarely mentioned, although it can be fatal without proper insulin treatment.
So, what is type 1 diabetes?
Type 1 diabetes is a condition in which the pancreas stops producing insulin, a hormone responsible for regulating blood sugar by increasing or decreasing absorption of the liver, fats, and other cells. This is not the same as type 2 diabetes – which accounts for more than 90% of all diabetes in the country – where insulin production in the body decreases or cells become resistant to insulin.
“Type 1 diabetes is most prevalent in children and adolescents. Although this virus is small, it is much worse than type 2 diabetes. Unlike type 2 diabetes where the body produces a certain amount of insulin and can be controlled by various drugs, when a person with type 1 diabetes stops taking insulin, he or she dies within weeks. . The body produces zero insulin, ”said Dr. V Mohan, chairman of the Dr. Mohan’s Diabetes Specialties Center, and one of the authors of the guidelines.
Before insulin was discovered 101 years ago, these babies died within months of being diagnosed. Now, with better insulin and a variety of new substances, they live longer. My old patient with type 1 diabetes is now 90; he was found at the age of 16, ”he said.
Children with this condition are more likely to be in the hospital with severe symptoms of frequent urination, and severe dehydration, and about a third of them have diabetes ketoacidosis (a critical condition when the body has too many ketones, a molecule produced when the body is absent. ‘Can absorb glucose so that be strong and start breaking down fat instead).
How rare is it?
There are more than 10 lakh children and adolescents living with type 1 diabetes in the world, and India is ranked in the highest numbers. Of the 2.5 lakh people living with type 1 diabetes in India, 90,000 to 1 lakh are under the age of 14. In essence, the number of Indians living with diabetes was 7.7 crore in 2019, according to the Diabetes Atlas of the International Diabetes Federation.
The guidelines, which distinguish type 1 diabetes from other uncommon types, also discuss how an increase in type 2 diabetes due to obesity in adolescents can lead to confusion. Of people with diabetes below the age of 25, 25.3% have type 2.
Who is at risk for type 1 diabetes?
The exact cause of type 1 diabetes is unknown, but it is thought to be an autoimmune condition in which the immune system destroys islets from the pancreas that produce insulin.
Genetic factors play a role in determining whether a person will have type 1 diabetes. The chances of getting the disease in a child are 3% if the mother has it, 5% if the father has it, and 8% if your sibling has it.
The presence of certain genes is also closely associated with disease. For example, an increase in genes DR3-DQ2 and DR4-DQ8 is 30-40% in patients with type 1 diabetes compared with 2.4% of the general population, according to the guidelines.
What are the guidelines?
Turning to 173 pages, it has been developed by leading diabetes doctors including Dr. Nikhil Tandon, head of the department of endocrinology at the All India Institute of Medical Sciences (AIIMS), New Delhi. “There have been many guidelines from international institutions. However, these are the first Indian guidelines that look at everything from diagnosis, treatment and management of type 1 diabetes. It provides detailed guidelines for managing the disease in various situations such as when a person is pregnant or on the move, ”said Dr V Mohan.
The guidelines provide information on diet and exercise, insulin monitoring, and prevention and treatment of complications such as retinopathy, kidney disease, and neurological disorders. Dr said the guidelines would hopefully serve as a guide for all practicing physicians in improving the care of pediatric patients and those living with the disease.
The same guidebook for type 2 diabetes already exists.
How did the treatment of type 1 diabetes develop over the years?
Insulin discovery has helped children with the disease to survive, Dr. Mohan said, “but they still have to continue to work hard to bring insulin into their lives. increases islets cells ”.
“Every child in the world should have access to insulin, which is an important drug. In India, half the people can afford it, and the other half can afford it at most public hospitals. It costs R5 000 a month, ”he said.
Dr Mohan said continuous monitoring of sugar and pancreas products were already being made available, although these are the first reports and it may take a few years for these drugs to become available as treatment. “Continuous glucose monitoring devices can help monitor blood sugar levels throughout the 24 hours with the help of a neurologist. Artificial insemination is advanced and in combination with monitoring levels can automatically supply insulin when needed, ”he said.
Guidelines say, “Consideration of costs is still an issue in India. As a result of better management, diabetes ketoacidosis is becoming less common, although in rural areas, and in nearby facilities, it remains a major problem. ”
The guidelines also adopt modern glucomers. Monitoring of urine sugar (not blood sugar) was common before glucomers. And, at first, even glucomers were expensive, painful, expensive, and inaccurate. “Today, we have blood glucose monitors that are extremely accurate and painless. The cost of pamphlets, however, remains a challenge, ”said the guidelines.