Type 1 Diabetes in India: The Numbers Show the Way Ahead

One-Year follow-up of 50 Rural Underprivileged Type 1 Diabetes Children on Insulin Pump Therapy: Breaking Socio-Economic Barriers in Diabetes Technologies

Aims

To audit the feasibility and clinical outcomes of fifty rural underprivileged children with Type 1 diabetes on insulin pump therapy for a one-year duration.

Material and Methods

All patients were audited from the Type 1 database of Madhuram Diabetes and Thyroid Centre (Unit of Idhayangal Charitable Trust www.idhayangal.org, NGO focussed on Type 1 diabetes from poor socio-economic strata). Below Poverty Line (BPL) was defined as any family earning less than Rs 2 lacs per annum. All children acted as their own controls managed on MDI for at least six months before pump start. Data were tabulated in Microsoft Excel and analysed.

Results

There were significant reductions in glycosylated haemoglobin at 6 months and one-year of insulin pump therapy compared to baseline pre-pump MDI values. In addition, significant reductions in diabetic ketoacidosis and severe hypoglycaemia admissions were seen.

Conclusion

Insulin pump therapy without prejudice on indicated well-selected rural underprivileged children with Type 1 diabetes leads to clinically meaningful outcomes. NGO-Private-Industry partnership is vital to expand access of modern diabetes technologies to reach the most underprivileged.

Prevalence and Determinants of Occurrence of Dyslipidemia in Subjects with Type 1 Diabetes Mellitus

OBJECTIVE

To describe the prevalence and determinants of occurrence of dyslipidemia in children and adolescents with type 1 diabetes mellitus (T1DM).

METHODS

A cross-sectional study was conducted in the diabetic clinic of a tertiary care referral hospital over two years. Subjects with T1DM aged 2-18 y had assessment of Lipid profile after 12 h of fasting. Glycemic control was assessed by glycosylated hemoglobin (HbA1C). Modifiable and nonmodifiable determining factors were assessed during clinic visit as per standard criteria. Body mass index (BMI) more than 23^rd adult equivalent and 27^th adult equivalent were considered as overweight and obesity, respectively. Lipid parameters were considered as abnormal if: Low density lipoprotein (LDL) > 100 mg/dL, high density lipoprotein (HDL) < 40 mg/dL, triglycerides > 100 mg/dL (< 10 y) and > 130 mg/dL (> 10 y).

RESULTS

A total of 171 subjects (mean age: 11.8 ± 3.5 y, M:F = 75:96) were recruited during the study period. The mean fasting LDL level, HDL level, and triglyceride level observed in the study sample were 106.6 ± 26.9 mg/dL (62% abnormal), 52.6 ± 14.3 mg/dL (9.4% abnormal), and 85.3 ± 39.4 mg/dL (10.5% abnormal), respectively; 115 (67.3%) of the subjects had at least one abnormality in the serum lipid profile. On multivariate analysis, HbA1C was the most significant factor in determining the occurrence of dyslipidemia (p < 0.05). HbA1C was 9.9 ± 1.6 in subjects with abnormal LDL versus 9.1 ± 1.5 in those with normal LDL (p < 0.05).

CONCLUSION

Prevalence of dyslipidemia in the study children and adolescents with T1DM was 67.3%. HbA1C remains the most important modifiable determinant of the occurrence of dyslipidemia.

First report of COVID-19-associated rhino-orbito-cerebral mucormycosis in pediatric patients with type 1 diabetes mellitus

Coronavirus disease 2019 (COVID-19) is a major public health problem worldwide. These patients are at increased risk of developing secondary infections due to a combination of virus- and drug-induced immunosuppression. Recently, several countries have reported an emergence of COVID-19 associated mucormycosis (CAM), particularly among patients with uncontrolled diabetes, with India reporting an alarming increase in rhino-orbito-cerebral mucormycosis (ROCM) in post-COVID cases. Hyperglycemia and diabetic ketoacidosis (DKA) are the major underlying risk factors. So far, case reports and review articles have reported CAM only in adult patients. Here, we describe the first cases of COVID-19-associated ROCM in two pediatric patients with Type 1 diabetes mellitus (DM). Both the cases had asymptomatic infection with SARS-CoV-2 and developed ROCM during the course of treatment of DKA. None of them had exposure to systemic steroids. Imaging findings in both cases revealed involvement of orbit, paranasal sinuses, and brain with cavernous sinus thrombosis. The patients underwent craniotomy with evacuation of abscess. Microbiological and histopathological findings were consistent with the diagnosis of mycormycosis, with fungal culture growing Rhizopus arrhizus. Post-operatively, the patients received liposomal amphotericin B (LAMB) and systemic antibiotics. Retrobulbar injection of LAMB was given in an attempt to halt orbital disease progression. However, it wasn't successful and both of them had to undergo orbital exenteration eventually. ROCM is a rapidly progressive disease and prompt diagnosis with aggressive surgery and timely initiation of antifungal therapy can be life-saving. Physicians should have a high index of suspicion, so as to avoid a delayed diagnosis, particularly in post-COVID patients with uncontrolled diabetes.