Taking cognizance of the rising cases of type 1 diabetes among the younger population in the country, the Indian Council of Medical Research (ICMR) on June 6 released guidelines for the management of type 1 diabetes mellitus (T1DM).
“In India, diabetes in the young presents a fascinating array of different types of diabetes of which type 1 diabetes would be the commonest in children and adolescents. One should, however, also keep in mind that type 2 diabetes is also now becoming more common in children,” the ICMR guidelines said.
Dr V Mohan, Chairman and Chief Diabetologist, Dr Mohan’s Diabetes Specialities Centre in Chennai, and Dr Nikhil Tandon, Head, Department of Endocrinology and Metabolism, AIIMS, New Delhi, have conceptualised the guidance document for management of type 1 diabetes.
The ICMR earlier brought out the guidelines for type 2 diabetes, and now the guidelines for the management of type 1 diabetes have been released.
The guidelines talk about the management of diabetes, right from nutritional habits to insulin use and the health problems related to the disease if not controlled.
Also read: Smart insulin is the future: Vikrant Shrotriya of Novo Nordisk
“The commonest form of diabetes is type 2 diabetes and it usually comes in adults. The second commonest form of diabetes which usually affects children and is often seen in adults also is type-1 diabetes. In this type of diabetes, there is no insulin production at all, and the only treatment available is insulin administration,” Dr V Mohan told Moneycontrol.
The guidance document by the ICMR is a compilation of different chapters on type 1 diabetes from the epidemiology, diagnosis and differential diagnosis of type 1 diabetes to lifestyle, diet and exercise, insulin, monitoring, acute complications, and microvascular complications.
Epidemiology of type 1 diabetes in India
The autoimmune type 1 diabetes disease is characterised by insulin deficiency and hyperglycemia in people with underlying genetic susceptibility.
The incidence of T1DM in India is 4.9 cases in one lakh population per year.
The peak incidence for T1DM is seen between 10 and 14 years of age, though 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 guidance document said.
Improved detection with increased diagnosis
Noting that an increasing number of children are being diagnosed with type 1 diabetes in India, the guidelines said the actual prevalence of the disorder is going up in the country.
“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,” it added.
The document also states that the arrival of Continuous Glucose Monitoring (CGM) has caused a paradigm shift in the monitoring and control of type 1 diabetes across the world although cost considerations remain an issue in India.
Nutritional recommendations for individuals with type 1 diabetes
The ICMR document calls for maintaining the glycemia in the normal to the near-normal range with minimal or no hypoglycaemia and maintaining optimal blood pressure, weight, and lipid levels.
The document highlights the importance of physical activity and nutritional requirements for the management of type 1 diabetes.
Carbohydrates: The recommended carbohydrate intake is 50-55 percent of total calories.
Fibre: Dietary fibre is a non-digestible complex carbohydrate derived from foods of plant origin. The recommended dietary fibre intake for children more or equal to one year of age is 14 g per 1000 kcal.
Fat: Recommended daily intake for fats is up to 30 percent of total calories. Infants and children younger than two years of age may have a higher daily fat intake of up to 35 percent.
Proteins: The protein requirement in children and adolescents varies from 2 g/kg at one year, 1 g/kg at ten years to 0.8-0.9 g/kg in adolescence. Recommended protein intake is 15-20 percent of the caloric requirement.
Vitamins and minerals: Vitamin and mineral requirements in children with diabetes are the same as in other healthy children. There is no clear evidence to suggest that routine vitamin or mineral supplementation in children with diabetes is beneficial.
Salt: Daily salt intake should be limited to 1,000 mg (2.5 g salt) in 1–3 years old children, 1,200 mg (3 g salt) in four to eight years old children, 1,500 mg (3.8 g salt) for children and adolescents aged less more than nine years and 2,300 mg (6.0 g salt) in adults. Processed foods are rich in salt, and hence their intake should be limited.
Discover the latest Business News, Sensex, and Nifty updates. Obtain Personal Finance insights, tax queries, and expert opinions on Moneycontrol or download the Moneycontrol App to stay updated!
