Severe limited joint mobility syndrome in a child with type 1 diabetes mellitus

LIMITED JOINT MOBILITY IN A CHILD WITH TYPE 1 DIABETES MELLITUS

Chronic uncontrolled type 1 diabetes mellitus (type 1DM) is a very major risk for chronic systemic complications; specifically, the microvascular and macrovascular ones. Limited joint mobility (LJM) is a rare disease that complicates all types of diabetes and might indicate the high-risk odd for the diabetic patients to develop microvascular complications. We are reporting a 13-year-old female child with chronic uncontrolled type 1DM presenting with full blown clinical picture of bilateral hand LJM associated with significant growth failure yet has no clinical or biochemical evidence of microvascular complications. Literature research studies have emphasized the rarity of this manifestation in pediatric type 1 diabetic patients; however, it is an important clue and warning sign for microvascular complication occurrence in these patients.

Management of type 1 diabetes in children and adolescents

Type 1 diabetes (T1D) is estimated to have a prevalence of approximately 1 in 5000 among Indian children. Living with T1D is a challenge for the child and the family because of the significant burden of treatment in terms of regular injections and monitoring of blood sugar, and risk of acute and long term complications that this condition imposes. Optimal glycemic control in T1D requires a meticulous balance of insulin therapy with diet and exercise. With the earlier insulin regimens this required lot of discipline in the eating and activity pattern, which led to significant curtailment of the lifestyle. Now, with availability of better insulins, delivery and monitoring devices, greater flexibility in lifestyle has become possible. The ultimate breakthrough in terms of therapy of T1D shall be easy availability of accurate and affordable closed loop systems, and 'cure' through islet or stem cell transplant. A review of the ambulatory management of T1D in children and adolescents and the upcoming therapeutic advances is being presented in this paper.