• With the medical fraternity still clueless about its cause, let alone cure, and the Indian government indifferent to the enormity of the problem, the future of child patients with type 1 diabetes mellitus (T1DM), whose numbers are increasing by the day, appears to be in the dark. On the eve of World Diabetes Day, and Children’s Day in the country, doctors from the department of Paediatric Medicine in the Post Graduate Institute of Medical Education and Research (PGI, for short) Chandigarh warn that though diabetes occurs far less commonly in children when compared to adults, its standard treatment regimen is very rogorous and stressful on the child as well as the family and a lifelong unaffordable financial burden on them.

Dr Rakesh Kumar, additional professor, and Dr Jaivinder, assistant professor, told media persons during an interaction on Monday that the disorder poses a significant public health burden considering the number of children below 15 years with T1DM. It accounts for about 5%–10% of all cases of diabetes. As per International Diabetes Federation 2015 estimates, out of 5.42 lakh children with type 1 diabetes worldwide, 70,200 (13%) are in India alone.

Photo By: Life in Chandigarh

Further, it is estimated that another 86,000 children below 15 years develop T1DM every year. India is second only to USA in the number of children having T1DM. Exact incidence and prevalence data of the country is lacking as there is no type 1 diabetes registry in India. Some small population-based studies in India suggest incidence of T1DM varying from 0.5 to 10 per lakh per year in children below 15 years, the doctors informed.

Dr Rakesh Kumar said as many as 1120 children with type 1 diabetes have been registered till date in the Paediatric Diabetes Clinic which has been running in the Advanced Paediatric Centre of PGI for the last 12 years. On an average, 4-5 new patients of the disorder report to the clinic every week.

“A study from our clinic showed that nearly 20-25% of children with type 1 diabetes have some form of psychological problem. Commonest problems observed were conduct disorders (24.5%), special symptoms (24%), physical illness (23%), anxiety (10%) and depression (7%). It was seen that poor sugar control and more number of hospitalisations were the two important factors associated with psychological problems.

“In another recently conducted study at our centre it was observed that use of continuous glucose monitoring systems may improve glucose control and another study showed that poor glucose control for three years severely affects growth of children with type 1 diabetes,” Dr Rakesh Kumar added.

The doctors said more than anything else, diagnosis of the disorder in their child comes as a major shock to parents, especially when they learn that their child will require lifelong insulin injections 3-4 times per day and the same number of finger pricks per day for checking sugar with a glucose meter. Parents and guardians go through a phase of shock, refusal, anger, anxiety, guilt, etc. all at the same time.

One of the most difficult problems these families face is a lifelong  financial burden as the average cost for treating a child with T1DM is around Rs 3000-4000 per month which badly affects the budget of a family with average income in India. In the developed countries, most of these children are treated with insulin pumps which have a one time cost of around 2.5 lakh rupees (cheaper model) with a running cost of nearly Rs 8000-9000 per month.

A group of patients of type 1 diabetes in Chandigarh have recently launched a registered organisation by the name Association for Children With Type 1 Diabetes to help raise funds for families who cannot afford the expensive therapy for the disorder. They have demanded that the central and state governments consider providing treatment for the disorder free of cost on the lines available to patients of haemophilia, thalassemia, HIV and TB to mitigate the sufferings of the affected families.

Causes

Researchers worldwide have been trying to pinpoint the exact cause of type 1 diabetes, but success has eluded them so far. But it is known that in most people with type 1 diabetes, the body's immune system — which normally fights harmful bacteria and viruses — mistakenly destroys insulin-producing (islet) cells in the pancreas. Genetics and environmental factors appear to play a role in this process.

Symptoms
•    Increased thirst and frequent urination
•    Extreme hunger
•    Weight loss
•    Fatigue
•    Irritability or behaviour changes
•    Foul smelling breath
•    Blurred vision

Complications
•    Heart and blood vessel disease
•    Nerve damage
•    Kidney damage
•    Eye damage
•    Skin conditions
•    Osteoporosis

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