Prevalence of nephropathy in Indian children and youth with type 1 diabetes mellitus

Prevalence and Predictors of Diabetic Retinopathy, Its Progression and Regression in Indian Children and Youth With Type-1 Diabetes

Objective

There are very few reports on the prevalence of diabetic retinopathy (DR) in children and youth with type-1 diabetes (T1D). Studies have also found very low rates of referral for DR screening in children and youth with T1D. We conducted this study to determine the prevalence of DR, to study the reliability of ISPAD screening recommendations and to identify predictors of DR, its progression and regression in Indian children and youth with T1D.

Methods

This study included 882 children and youth with T1D. Demographic data, anthropometry, blood pressure, sexual maturity rating, ophthalmological examination (slit lamp for cataract) and biochemical measurements were performed using standard protocols. Fundus images were captured using the Forus Health 3netra classic digital non-mydriatic fundus camera by the same experienced operator. De-identified images were assessed by a senior grader and ophthalmologist (Belfast Ophthalmic Reading Center). Severity of DR was graded as per the UK National Health Service (NHS) DR classification scale.

Result

We report 6.4% and 0.2% prevalence of DR and cataract in Indian children and youth with T1D, respectively. All the subjects with DR had early non-proliferative DR. We report that amongst subjects with DR, only 2 subjects were aged less than 11 years and had duration of illness less than 2 years. Presence of hypertension and older age were significant predictors of DR (P < .05). Subjects with DR had significantly higher triglyceride concentrations (P < .05), of these, 6.9% had progression and 2.9% had regression at 1 year follow up; the change in glycaemic control was a significant positive predictor of progression of DR (P < .05). None of the participants included in the study progressed to develop sight-threatening DR.

Conclusion

DR is not uncommon in Indian children and youth with T1D, thus screening for DR needs to be initiated early, particularly in older individuals with higher disease duration. Controlling blood pressure and triglyceride concentrations may prevent occurrence of DR. Improving glycaemic control may prevent progression of DR in Indian children and youth with T1D.

Epidemiology of type 1 diabetes mellitus in children in Kazakhstan: Data from unified national electronic health system 2014-2021

The epidemiology of type 1 diabetes mellitus (T1DM) in children aged 0-17 in Kazakhstan was explored using aggregated large-scale healthcare data from the unified national electronic health system (UNEHS) in 2014-2021. Incidence, period prevalence, and mortality rates per 100,000 population at risk were calculated. Cox proportional hazards regression modelling and Kaplan-Meier methodology were used. The follow-up period was from the initial date of T1DM until death or the end of the follow-up (31 December 2021). Among the 11,088 patients, the incidence rate of T1DM decreased from 28.1 to 24.5 per 100,000 population, whereas the period prevalence rate increased from 48.8 to 179.1, and the mortality rate rose from 0.18 to 0.67. Diagnosis at age 0-1 years (hazards ratio [HR] 4.42), presence of nephropathy (HR 8.94) or neoplasms (HR 1.64) were associated with a higher risk of death, while the presence of retinopathy (HR 0.31) was associated with a lower risk of death.

Insulin Resistance in Adolescents and Youth With Type 1 Diabetes: A Review of Problems and Solutions

Though insulin resistance (IR) was previously considered a feature of only type 2 Diabetes (T2DM), its development in type 1 Diabetes (T1DM) is not an uncommon occurrence, the causes of which are multifactorial (gender, pubertal status, diabetes duration, ethnicity, genetics, adiposity, glycemic control, chronic inflammation). Despite improvements in glucose, blood pressure and lipid profile, vascular complications (coronary artery disease and nephropathy) continue to remain common causes of morbidity and mortality in T1DM. Aggressive glycemic control reduces but does not eliminate the risk of IR. IR accelerates the development of micro and macrovascular complications, many of which can be potentially reversed if diagnosed and managed early. Lack of endogenous insulin production makes estimation of insulin sensitivity in T1DM difficult. As hyperinsulinemic-euglycemic clamp studies are cumbersome and invasive, the use of prediction equations for calculating estimated insulin sensitivity may prove to be useful. Along with intensive insulin therapy, dietary modifications and increasing physical activity, the role of Metformin in managing IR in T1DM is becoming increasingly popular. Metformin adjunct therapy in T1DM has been shown to improve insulin sensitivity, glycemic control, lipid profile, body composition, vascular smooth muscle function, thereby reducing the risk of vascular complications, as well as reversal of early vascular dysfunction. However, further studies to assess long-term efficacy and safety of Metformin use in adolescents and youth with T1DM are needed. This review aims at revisiting the pathophysiology of IR in T1DM and techniques of identifying those at risk so as to put into action various strategies for management of the same.

Adiponectin-leptin ratio as a marker of cardio-metabolic risk in Indian children and youth with type 1 diabetes

OBJECTIVES

Adiponectin/leptin ratio (ALR) is a promising novel marker of cardio-metabolic risk in patients with metabolic syndrome. Our aim was to study the association of adiponectin-leptin ratio with markers of obesity and adiposity and also to assess its usefulness as a marker of increased cardiometabolic risk (CMR) in Indian children and youth with type 1 diabetes mellitus.

METHODS

This observational study included 79 children and youth with type 1 diabetes (T1DM) (10-21 years) having disease duration>6 months. Demographic data and laboratory findings were obtained from patients' records. Patients with ALR<1 were categorised as having increased CMR and those with ALR>1 were categorised as having no CMR.

RESULTS

ALR showed a significant negative correlation with body mass index (BMI), waist and hip circumference and body fat percentage (p<0.05). Body fat percentage was the single most important predictor of ALR. Children and youth with increased CMR had higher weight, BMI, waist and hip circumferences and body fat percentage as compared to those with no CMR (p<0.05). In T1DM children with dyslipidemia, ALR was significantly lower as compared to those without dyslipidemia (p<0.05).

CONCLUSIONS

ALR may be a useful marker for adiposity and increased cardiometabolic risk in Indian children and youth with type 1 diabetes mellitus.

A Pilot Study to Assess Effect of Metformin Therapy on Prevention of Double Diabetes in Indian Adolescents with Type-1 Diabetes

Introduction

Increased prevalence of metabolic syndrome in Indian adolescents owing to the obesity epidemic leads to double diabetes (DD), which is associated with an increased risk of complications in type-1 diabetes (T1D). Metformin may be a useful intervention for the prevention and treatment of insulin resistance in T1D. We conducted this pilot randomized controlled trial with the objective of investigating the effect of metformin on insulin sensitivity in Indian adolescents with T1D.

Method

This pilot randomized controlled trial was performed on 59 participants with T1D aged 10-19 years distributed uniformly by gender and puberty across two groups with a 3-month intervention period. The intervention group received metformin (weight less than 60 kg received 500 mg twice daily and more than 60 kg received 1 gm twice daily) and non-metformin group received standard of care for diabetes. Anthropometric, clinical details, biochemistry and insulin sensitivity indices (ISI) were evaluated using standard protocols at baseline and endline.

Result

22.2% of subjects from non-metformin group and 12.5% from metformin group were at the risk of the development of DD. The odds ratio and relative risk for the development of DD in non-metformin subjects were 2.0 and 1.4, respectively, as compared to participants in metformin group. The mean improvement in ISI ranged from 1.4% to 4.6% in participants on metformin as opposed to deterioration of -2% to -14.1% in non-metformin group. On performing the paired sample t-test, the reduction in ISI in non-metformin group was significant.

Conclusion

Metformin may prevent deterioration in insulin sensitivity in Indian adolescents with T1D.

Triple burden of malnutrition and role of anaemia in the development of complications associated with type 1 diabetes in Indian children and youth

OBJECTIVES

The double burden of malnutrition accompanied by micronutrient deficiency is referred to as the triple burden of malnutrition (TBM). Very few studies have highlighted the TBM in children with type-1 diabetes. We conducted this study with the objective of estimating the TBM in Indian children and youth with type-1 diabetes (T1D) and to study role of anaemia in the development of complications associated with T1D.

METHODS

This cross-sectional observational study included 394 subjects with T1D. Demographic data, anthropometry, blood pressure, biochemical measurements, dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography were performed using standard protocols. Estimated glucose disposal rate (eGDR) and estimated glomerular filtration rate (eGFR) were calculated for all subjects.

RESULTS

We report a 16, 5.8, and 16.2% prevalence of anaemia, underweight and overweight/obese suggesting TBM with microcytic hypochromic anaemia as the most common morphological form. Haemoglobin concentrations showed positive correlation with systolic and diastolic blood pressure. The presence of anaemia was a significant predictor of eGDR and macrovascular complications in T1D which could not be attributed to glycemic control. Bone health of anaemic T1D subjects was poor than subjects without anaemia on DXA scan after adjusting for confounders. No systematic pattern between Hb concentrations and eGFR or ACR was found.

CONCLUSIONS

TBM in Indian children and youth with T1D is a significant health problem and anaemia is an important predictor in the development of macrovascular complications and poor bone health associated with T1D. However, its role in development of microvascular complications remains to be explored.