New Delhi: Recent estimates from the International Diabetes Federation has suggested that India has the highest number of incident and prevalent cases of type 1 diabetes in the world. "Individuals with type 1 diabetes need support to survive, using insulin and other therapies, and to live their entire life with stigma, restrictions, or disabling complications due to their illness," said a guidelines prepared by Indian Council of Medical Research (ICMR).
Type 1 Diabetes mellitus (T1DM) is an autoimmune disease characterised by insulin deficiency and hyperglycemia in people with underlying genetic susceptibility. The incidence of T1DM is India is 4.9 cases/100000/year. The peak incidence for T1DM is seen between 10-14 years of age, through it can affect an individual at any age.
Genetic factors play a significant role in the etiology of T1DM. The risk of T1DM is 3 percent, 5 percent and 8 percent respectively, when mother, father and sibling have T1DM. The ICMR type 1 diabetes guidelines comes at a time when the SARS-CoV-2 pandemic has disproportionately affected people with diabetes population, exposing them to a high risk for severe illness and mortality.
Globally, diabetes was responsible for over four million deaths in the year 2019. It was the leading cause of end-stage kidney disease, adult-onset blindness and cardiovascular disease. India is home to world's second-largest adult diabetes population and every sixth person with diabetes in the world is an India. The past three decades witnessed 150 percent increase in the number of people with diabetes in the country.
Over one million children and adolescents in the world have type 1 diabetes, and recent estimates from the International Diabetes Federation have suggested that India has the highest number of incidents and prevalent cases of type 1 diabetes in the world. "Intensive management of all aspects of diabetes, especially glycemic control, is gold standard in type 1 diabetes management. At the same time, there is significant advancement in technology for diabetes care including newer insulin analogues, pumps, automated insulin delivery systems and sensors," the ICMR guidelines said.
It said that, in India, there exists considerable variability in the quality of diabetes care, which depends upon various factors such as accessibility to services, affordability of drugs, attitude and perceptions of care providers and treatment guidelines among others. "Today, more and more children are being diagnosed with type 1 diabetes in our country. This may be because of actual prevalence of the disorder is going up in India. It may also reflect better awareness and therefore, improved diagnosis of type 1 diabetes. Finally, it could be that children are surviving more due to early diagnosis and better treatment," the ICMR guidelines said.
Management options for children with type 1 diabetes have greatly improved in the last 3-4 decades. In the 1960s and 70s, urine glucose monitoring was the norm and glucometers have not arrived. Even when they did, they were expensive, painful, extremely cumbersome and mostly inaccurate. Today, we have blood glucose monitors which are extremely precise, and are less painful. Cost of stripes however, still remains a challenge, the ICMR said.
"With the arrival of Continuous Glucose Monitoring (CGM), a paradigm shift in the monitoring and control of type 1 diabetes has occurred all over the world, although again, cost considerations remain an issue in India," the ICMR said. The guidelines further said that all children and adults with T1DM require insulin as soon as they are diagnosed and continuously and thereafter throughout life.
