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Gupta S, Ramteke H, Gupta S, Gupta S, Gupta KS. Are People With Type 1 Diabetes Mellitus Appropriately Following Insulin Injection Technique Practices: A Review of Literature. Cureus 2024; 16:e51494. [PMID: 38304656 PMCID: PMC10831209 DOI: 10.7759/cureus.51494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/01/2024] [Indexed: 02/03/2024] Open
Abstract
People with type 1 diabetes mellitus (T1DM) need to take multiple doses of insulin injections daily throughout their lives. However, a notable portion of people with diabetes mellitus (DM) show suboptimal insulin injection technique practices. They are supposed to follow the recommended insulin injection technique guidelines. Our explorative literature search, including studies from the past 30 years, is expected to identify the deficiencies of self-injection insulin techniques and the associated complications in people with T1DM, where we have summarised the overall incidence of complications that have occurred due to nonadherence of the prescribed guidelines, along with their associated risk factors. We have attempted to include multiple systematic reviews, meta-analyses, literature reviews, case reports, and original articles from the search engines and databases like PubMed, Scopus, ScienceDirect, Cochrane Library, Google Scholar, and BioMed Central, and studies with only human participants were included in this search. The knowledge sharing from this research may be utilised for enhancing the structured education diabetes programme and implementing the population-based corrective measures, including the thrust areas in future multi-centre longitudinal research studies and recommendations, which can prevent unnecessary complications and enhance their quality of life. Correct insulin administration technique, abstaining from administration of injection at the areas with lipohypertrophy, rotation of injection sites, and ultrasound scanning can be used as a complimentary method to detect the lipohypertrophy at an early stage. Liposuction is beneficial in reducing the extensive lipohypertrophic tissues but helps achieve only cosmetically satisfactory outcome; thus, empowering people to follow insulin injection technique guidelines is one of the best strategies to reduce the high prevalence of lipohypertrophy. To conclude, education among the people with DM, especially T1DM who have to take insulin regularly, needs to be carried out consistently in the clinical settings, to prevent the severe complications caused due to inappropriate insulin injection techniques.
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Affiliation(s)
- Swar Gupta
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshal Ramteke
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shlok Gupta
- Internal Medicine, Sunil's Diabetes Care n' Research Centre, Nagpur, IND
| | - Sunil Gupta
- Diabetology, Sunil's Diabetes Care n' Research Centre, Nagpur, IND
| | - Kavita S Gupta
- Nutrition, Sunil's Diabetes Care n' Research Centre, Nagpur, IND
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Dabas H, Sarin J, Madhu S. Insulin Adherence in Adolescents with Type 1 Diabetes Mellitus. Indian J Endocrinol Metab 2023; 27:394-397. [PMID: 38107739 PMCID: PMC10723607 DOI: 10.4103/ijem.ijem_294_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 04/29/2023] [Accepted: 06/09/2023] [Indexed: 12/19/2023] Open
Abstract
Adherence to medication, especially insulin, is a key contributor to diabetes treatment outcomes. Lack of adherence is common among patients with type 1 diabetes mellitus (T1DM) ranging from 23% to 77%, with a higher frequency in developing countries. Poor adherence results in worse glycaemic control and increased mortality and morbidity due to diabetes complications. The objective of this study is to discuss insulin adherence among adolescents with T1DM. The review was conducted through search engines such as PubMed, Medline, Embase and Google Scholar. Search terms used were 'type 1diabetes mellitus', 'insulin dependent diabetes mellitus', 'Juvenile diabetes mellitus', 'adherence', 'compliance', 'non adherence', 'barriers', 'omission', 'medical adherence', 'adolescents', 'teenagers' and 'insulin'. T1DM is challenging for adolescents due to its lifelong treatment regimens. Educational programmes and specific interventions which can improve affordability, accessibility and administration of insulin should be implemented to improve insulin adherence among adolescents.
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Affiliation(s)
- Heena Dabas
- Florence Nightingale College of Nursing, Guru Teg Bahadur Hospital, Delhi, India
| | - Jyoti Sarin
- Maharishi Markendshwar College of Nursing, Ambala, Haryana, India
| | - S.V. Madhu
- Centre for Diabetes, Endocrinology and Metabolism, UCMS-GTB Hospital, Delhi, India
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Bhattacharya S, Kalra S. South Asian Endocrinology: Challenges and Concerns, Collaboration and Consolidation. Indian J Endocrinol Metab 2023; 27:373-376. [PMID: 38107736 PMCID: PMC10723606 DOI: 10.4103/ijem.ijem_334_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/10/2023] [Indexed: 12/19/2023] Open
Abstract
The practice of endocrinology in South Asia poses many challenges but simultaneously offers unique opportunities. The population in this region is predisposed to diabetes and cardiovascular disease at a much lower body mass index compared to Caucasians. Dietary deficiencies, higher prevalence of infection and distinct environmental and genetic factors further complicate the presentation of endocrine disorders. Over the past few decades, important breakthroughs have been made to confront these challenges. Collaboration among the endocrine fraternity of the South Asian countries will help to consolidate these gains and pave the way forward for a healthier region.
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Affiliation(s)
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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Jawale S. Intrapancreatic autologous stem cell therapy for type 1 diabetes - an experimental study. Ann Med Surg (Lond) 2023; 85:4355-4371. [PMID: 37663700 PMCID: PMC10473305 DOI: 10.1097/ms9.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/01/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Type 1 diabetes, also known as juvenile diabetes or insulin-dependent diabetes, is a chronic autoimmune condition in which the pancreas makes little or no insulin leading to resultant hyperglycemia. The incidence of type 1 diabetes in India is 0.26 per 1000 children. Materials and methods The author treated 25 patients with type 1 diabetes with autologous intrapancreatic stem cell therapy in the last 5 years. A group of 26 patients of type 1 diabetes with conventional treatment of insulin injections was put as a control group in the same period. Results The results of the therapy group were substantially superior to the control group, which came statistically highly significant. The variable compared were weight gain, the daily requirement of insulin and its drop after therapy, the rise of C-peptide levels and drop in anti-glutamic acid decarboxylase antibody, drop in HbA1c levels, and drop in fasting and postprandial blood sugar. Discussion When stem cells are given intravenously, the majority are engulfed by the lungs and only a small fraction is delivered to the pancreas. When injected into the pancreas, through its arterial blood supply, due to the larger size and irregular shape of stem cells, they are retained in tissue spaces and do not escape from the venous side, thus achieving far higher concentration in the pancreas compared to the intravenous route. Conclusions Intrapancreatic stem cell therapy for type 1 diabetes is safe, affordable, and effective. It has the potential to become a viable treatment option for type 1 diabetes patients.
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Bharathy PS, Delhikumar CG, Rajappa M, Sahoo J, Anantharaj A. Early Markers of Atherosclerosis in Children and Adolescents with Type 1 Diabetes Mellitus. Indian J Pediatr 2023; 90:227-232. [PMID: 35962237 DOI: 10.1007/s12098-022-04314-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/10/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To detect early atherosclerosis changes using flow-mediated dilation (FMD) of the brachial artery, carotid intima-media thickness (CIMT), inflammatory markers (hs-CRP, IL-6), and endothelial markers (sICAM and sVCAM). METHODS The authors recruited 4 to 18-y-old children with type 1 diabetes mellitus (T1DM) and age- and sex-matched normal children, excluding those with familial hypercholesterolemia, syndromic disorders, and cardiovascular disease. CIMT and FMD were measured in both the groups. Biomarkers hs-CRP, IL-6, sICAM, and sVCAM, were analyzed in the T1DM group. RESULTS Forty T1DM children and 40 controls with 27 (67.5%) girls were enrolled in each group. The mean age was 9.68 y. The T1DM group had 4 (10%) obese and 4 (10%) overweight children. Among cases, 9 (22.5%) had diabetes for > 5 y, 24 (60%) required daily insulin between 0.8 and 1.2 IU/kg/d and 26 (65%) had HbA1c > 10 g/dL. The CIMT values were significantly higher in cases (0.69 mm) than in controls (0.59 mm); 29 (72.5%) cases had abnormal combined CIMT values. FMD was lesser in cases than in controls but not significant. The median values of hs-CRP, IL-6, sICAM, sVCAM were 0.81 mg/L, 6.27 pg/mL, 46.33 ng/mL and 668.81 ng/mL, respectively. A significant correlation of IL-6 with CIMT (r = 0.543, p = < 0.001) and sICAM with FMD (r = -0.397, p = 0.011) was observed. VCAM was low in the obese and overweight children. CONCLUSION Children with type 1 diabetes had higher CIMT than normal children, whereas FMD did not differ. The association between elevated inflammatory markers with high CIMT and low FMD indicates that inflammation plays an essential role in endothelial dysfunction.
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Affiliation(s)
| | - C G Delhikumar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
| | - Medha Rajappa
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jayaprakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Avinash Anantharaj
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Verma H, Verma PK, Kumar V, Bhat N, Bahurupi Y. Prevalence and Associated Clinical Features of Type 1 Diabetes Mellitus Among Children Presented to a Tertiary Health Care Center of Himalayan Foothills. Cureus 2023; 15:e35435. [PMID: 36994279 PMCID: PMC10041128 DOI: 10.7759/cureus.35435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/27/2023] Open
Abstract
Introduction Diabetes Mellitus (DM) is a complex metabolic disorder characterized by chronic hyperglycemia. Knowing its prevalence, associated clinical features, and complications is essential for diagnosing children having diabetes-like clinical features. Since there is a limited study from India and no similar study from this geographical part, the present study was carried out. Material and method It is a cross-sectional study, which includes children aged 1-18 years presented to the pediatric outpatient department (OPD), inpatient department (IPD), and emergency with clinical features of Type 1 Diabetes Mellitus (T1DM). The enrolled cases were assessed for confirmation of T1DM, and clinical features and associated complications were recorded in the case record form. Result A total of 218 children with clinical features of T1DM were enrolled, out of which 32 (14.7%) had T1DM. Among the 32 T1DM patients, 31 (96.9%) of the participants presented with polyuria, 29 (90.6%) had polydipsia, and 13 (40.6%) had polyphagia. Out of 32 children, 3 (9.38%) had diabetic neuropathy, and 1 (3.1%) had diabetic retinopathy. Conclusion We found that many children with diabetes have clinical features of T1DM and uncontrolled blood sugar. This emphasizes the need for early detection and treatment to prevent long-term complications.
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Botre AV, Kashyap V, Parikh T. The youngest patient with hemi-chorea and diabetic ketoacidosis as presenting manifestation of type 1 diabetes mellitus from India. Int J Diabetes Dev Ctries 2023. [DOI: 10.1007/s13410-023-01171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Maurya S, Kumar IR, Singh A, Mohanty S, Nagarathna R. Evaluating the Effectiveness of Yoga As An Adjunct Therapy In Type 1 Diabetes Care: Study Protocol of A Prospective Randomised Open Label Blinded End-point Trial. Advances in Integrative Medicine 2023. [DOI: 10.1016/j.aimed.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Rawal T, van Schayck OC, Willeboordse M, Arora M, Bhaumik S, Bhagra A, Bhagra S, Muris JW, Tandon N. How to promote a healthy lifestyle among schoolchildren: Development of an intervention module (i-PROMISe). Public Health in Practice 2022; 3:100262. [PMID: 36101760 PMCID: PMC9461553 DOI: 10.1016/j.puhip.2022.100262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 04/02/2022] [Accepted: 04/22/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Lifestyle preferences are inculcated in childhood and once established, persist into adulthood. The Project PROMoting Health LIteracy in School (i-PROMISe) aims to promote a healthy lifestyle among students for the universal prevention of non-communicable diseases (NCDs) like diabetes. Study design Qualitative study using focus-group-discussions (FGDs) and In-Depth Interviews (IDI). Method Project was undertaken in two-phases in two private schools in New Delhi, India. In phase-one, FGDs with students (grades IV to VIII) and IDIs with teachers were conducted to ascertain their perceptions of diabetes prevention and management according to the Health Belief Model. The data was analyzed using a thematic framework method. In phase-two, the resources were pre-tested and participants’ feedback was requested on the duration, quality, and understanding of the resources. Results In total, 89 students and 17 teachers participated in phase-one (n = 54 [in FGDs] and n = 5 [in IDIs]) and phase-two (n = 35 students and n = 12 teachers in FGDs). In phase-one, themes that emerged included: diabetes was considered a disease of the elderly; misconceptions about susceptibility to these diseases were common; children were largely aware of measures to prevent these diseases, but barriers to adopting a healthy lifestyle existed. Based on the findings, a comprehensive module was developed, which consisted of a teacher's manual with interactive activities and short films. The resources (teacher's manual and short films) were well received and contributed to a better understanding of diabetes and other NCDs; myths/misconceptions were clarified. Conclusion Development of resources using participatory approach can be effective in promoting and reinforcing healthy behaviours among school going children to prevent and control NCDs in schools.
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Affiliation(s)
- Tina Rawal
- Health Promotion Division, Public Health Foundation of India, Gurgaon, India
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Corresponding author. Health Promotion Division, Public Health Foundation of India (PHFI), Plot No. 47, Sector 44, Gurgaon (Haryana) 122002, India.
| | - Onno C.P. van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Maartje Willeboordse
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Monika Arora
- Health Promotion Division, Public Health Foundation of India, Gurgaon, India
| | - Soumyadeep Bhaumik
- Health Promotion Division, Public Health Foundation of India, Gurgaon, India
| | - Anjali Bhagra
- Mayo Clinic, Mayo Clinic, World India Diabetes Foundation, Rochester, United States
| | - Sumit Bhagra
- Mayo Clinic, Mayo Clinic, World India Diabetes Foundation, Rochester, United States
| | - Jean W.M. Muris
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Naik K, Magdum R, Ahuja A, Kaul S, S J, Mishra A, Patil M, Dhore DN, Alapati A. Ocular Surface Diseases in Patients With Diabetes. Cureus 2022; 14:e23401. [PMID: 35495002 PMCID: PMC9045461 DOI: 10.7759/cureus.23401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Diabetes is a major cause of ocular morbidity as multiple mechanisms play a role in inducing inflammatory changes in the eye. Diabetic retinopathy is the most common complication and is well-documented. However, in the era of modern medicine, attention is also being focused on ocular surface changes in diabetes. Therefore, this study aimed to determine the association between diabetes and ocular surface diseases. Materials and Methods This is a cross-sectional study examining 320 eyes of 160 patients with diabetes who were grouped according to their duration of diabetes. The symptoms were evaluated using the ocular surface disease index (OSDI) questionnaire. Their recent hemoglobin (Hb) A1c value was recorded. Their external or internal hordeolum, blepharitis, meibomian gland dysfunction, and corneal sensitivity were also evaluated. The tear film was examined using tests, such as Schirmer's test, tear film breakup time (TBUT), tear film meniscus height (TFMH), fluorescein stain, and rose bengal stain. The results were correlated with the duration and control of diabetes. Results The mean age of the study population was 56.60 years comprising 56% (n=89) females and 44% (n=71) males. The mean OSDI scores were 7.9 ± 3.55 and 57 ± 19.22 in patients without dry eye and with severe dry eye, respectively. The study observed OSDI scores were consistently high with diabetes severity. About 67% (n=24) of patients with HbA1c of >8% had dry eyes. Dry eye was found in 68% (n=59) of patients with the duration of diabetes being >10 years. About 23.7% (n=38) had blepharitis, whereas only 4% (n=7) had external or internal hordeolum and 44% (n=86) had different grades of meibomian gland dysfunction. Corneal sensitivity was abnormal in only 12% (n=12) of patients. About 55% (n=86) of patients had varying degrees of dry eye. A statistically significant correlation was found between the severity of dry eye and TBUT, TFMH values, and grades of corneal staining (P < 0.0001). Conclusion This study observed that the incidence of dry eyes was found to be higher when patients had uncontrolled diabetes and diabetes for a longer period. The OSDI scoring system is an important diagnostic tool while examining patients with dry eye. In an ophthalmology clinic, patients with diabetes should always be evaluated for any ocular surface changes when being screened for diabetic retinopathy, and proper guidelines should be implemented to detect changes in the ocular surface system as early as possible so that any long-term complications such as infectious or neurotrophic keratitis may be avoided at an early stage.
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Siddiqee MH, Bhattacharjee B, Siddiqi UR, Rahman MM. High burden of hypovitaminosis D among the children and adolescents in South Asia: a systematic review and meta-analysis. J Health Popul Nutr 2022; 41:10. [PMID: 35300737 PMCID: PMC8929474 DOI: 10.1186/s41043-022-00287-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 03/04/2022] [Indexed: 11/30/2022]
Abstract
Background Vitamin D is vital for the growth and development of children. While deficiency and/or insufficiency of vitamin D among South Asian children are frequently reported in the literature, the lack of a meta-analysis has left its true extent poorly characterized. In this study, we aimed to conduct a systematic review and perform meta-analyses of the prevalence of hypovitaminosis D among the children of the South Asian countries. Methods Two major electronic search engines (PubMed and Scopus) and one database (Google scholar) were used; original studies, conducted among South Asian children and adolescents and published between 1 January 2001 and 31 December 2019. A random-effect meta-analysis was also performed to calculate the pooled prevalence of hypovitaminosis D followed by subgroup analyses for countries and age groups. Results After applying inclusion and exclusion criteria, a total of 41 studies with a total population size of 18,233 were finally selected. The overall prevalence of hypovitaminosis D was 61% [95% CI: 46% to 71%] with highly significant heterogeneity (I2 = 99.72%; p < 0.0001). The average level of serum vitamin D ranged from 5 ng/mL to 34 ng/mL, with a weighted mean of 19.15 ng/mL (weighted standard deviation 11.59 ng/mL). Country-wise analysis showed that hypovitaminosis D in Afghanistan was the highest [96.2%; 95% CI: 91% to 99%], followed by Pakistan [94%; 95% CI: 90% to 96%], India [64%; 95% CI: 46% to 79%], Bangladesh [35.48%; 95% CI: 32% to 39%], Nepal [35%; 95% CI: 1% to 83%], and Sri Lanka [25%; 95% CI: 16% to 36%]. Age group analyses revealed that hypovitaminosis D was most prevalent among neonates [85%; 95% CI: 76% to 91%], followed by school-going children [57%; 95% CI: 33% to 80%], and preschool children [55%; 95% CI: 35% to 75%]. Conclusion This study generates quantitative evidence and specific extent of hypovitaminosis D in the South Asian countries as a public health concern. Being the first systematic review for this region, results from this study will create awareness and will facilitate adopting mitigation strategies by the policymakers and the governments to address this problem. Supplementary Information The online version contains supplementary material available at 10.1186/s41043-022-00287-w.
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Affiliation(s)
- Mahbubul H Siddiqee
- Department of Mathematics and Natural Sciences, School of Data and Sciences, BRAC University, Dhaka, 1212, Bangladesh. .,Research Wing, Red & White Innovations, Mirpur DOHS, Dhaka, 1216, Bangladesh.
| | - Badhan Bhattacharjee
- Department of Mathematics and Natural Sciences, School of Data and Sciences, BRAC University, Dhaka, 1212, Bangladesh.,Research Wing, Red & White Innovations, Mirpur DOHS, Dhaka, 1216, Bangladesh
| | - Umme Ruman Siddiqi
- Communicable Disease Control Unit (CDC), Directorate General of Health Services, Dhaka, 1212, Bangladesh
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Singla R, Bindra J, Singla A, Gupta G, Gupta Y, Aggarwal S. Automation of insulin bolus dose calculation in type 1 diabetes: a feasibility study. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Gowda V, Daasara G, Nanjundappa N, Nagarajappa V, Shivappa S. Prevalence of peripheral neuropathy in children with type 1 diabetes mellitus. J Pediatr Neurosci 2022. [DOI: 10.4103/jpn.jpn_179_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Diwakar J, Samaddar A, Konar SK, Bhat MD, Manuel E, Hb V, Bn N, Parveen A, Hajira SN, Srinivas D, S N. First report of COVID-19-associated rhino-orbito-cerebral mucormycosis in pediatric patients with type 1 diabetes mellitus. J Mycol Med 2021; 31:101203. [PMID: 34517273 PMCID: PMC8418383 DOI: 10.1016/j.mycmed.2021.101203] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Jyoti Diwakar
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Arghadip Samaddar
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Subhas Kanti Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Maya Dattatraya Bhat
- Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Emma Manuel
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Veenakumari Hb
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Nandeesh Bn
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Asmiya Parveen
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sadiya Noor Hajira
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Nagarathna S
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
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Kulkarni S, Ramachandran R, Sivaprasad S, Rani PK, Behera UC, Vignesh TP, Chawla G, Agarwal M, Mani SL, Ramasamy K, Raman R. Impact of treatment of diabetic macular edema on visual impairment in people with diabetes mellitus in India. Indian J Ophthalmol 2021; 69:671-676. [PMID: 33595499 PMCID: PMC7942112 DOI: 10.4103/ijo.ijo_2614_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: The aim of this study was to report visual and anatomical outcomes following treatment for diabetic macular edema (DME) in clinical practice in India. Methods: Retrospective chart review of patients with DME who were initiated on treatment and followed up for at least 1 year at 9 tertiary eye care centers during 2016–2017 was performed. Data on demographics, systemic illnesses, visual acuity and anatomical characteristics of DME, treatment history were collated and analyzed for change in visual acuity level and central macular thickness at 1 year. Results: A total 1853 patients were diagnosed with treatable DME during study period, 1315 patients were treated and 556 patients (1019 eyes) followed up at one year. Although patients achieved significantly better anatomical outcome (central macular thickness of <300μ in 32.3% at baseline compared to 60.7% at 1 year, P < 0.001), visual impairment due to DME did not differ from baseline (mild visual impairment in 53.2% at baseline compared to 56% at 1 year, P = 0.7). Cystoid type of DME was the most common phenotype (432/1019, 42.4%) followed by spongy type (325, 31.9%) and cystoid plus spongy type (138, 13.5%). Bevacizumab monotherapy was the most common (388/1019, 38.1%) treatment followed by combination therapy (359, 35.2%). Mean number of anti-VEGF injections received per eye in a year was 2.1 (SD ± 0.9). Conclusion: Only about a third of treated DME patients complete one year follow up in India. Most patients receive suboptimal number of treatments. Treated DME cases largely show better anatomical outcome but not a better functional outcome.
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Affiliation(s)
- Sucheta Kulkarni
- Department of Retina, PBMA's H.V. Desai Eye Hospital, Pune, India
| | - Rajalakshmi Ramachandran
- Department of Ophthalmology, Dr. Mohan's Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, London and University College London, London, UK
| | - Padmaja Kumari Rani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Umesh C Behera
- Department of Vitreo-Retina, L V Prasad Eye Institute, Bhubaneswar, India
| | - T P Vignesh
- Department of Retina-Vitreous, Aravind Eye Hospital, Madurai, India
| | - Gajendra Chawla
- Department of Retina, Vision Care & Research Centre, Bhopal, India
| | - Manisha Agarwal
- Department of Vitreoretina, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Sheena Liz Mani
- Department of Retina, Dr. Tony Fernandez Eye Hospital, Aluva, India
| | - Kim Ramasamy
- Department of Retina-Vitreous, Aravind Eye Hospital, Madurai, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
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Wagh A, Ekbote V, Khadilkar V, Khadilkar A. Trabecular Bone Score has Poor Association With pQCT Derived Trabecular Bone Density in Indian Children With Type 1 Diabetes and Healthy Controls. J Clin Densitom 2021; 24:268-274. [PMID: 33358221 DOI: 10.1016/j.jocd.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND In children with type 1 diabetes mellitus (T1DM), low trabecular volumetric bone mineral density (Trab vBMD) has been reported. However, studies using the trabecular bone score (TBS) are scarce. The objective of our study was to assess areal bone mineral density at the lumbar spine (LS aBMD), the TBS and Trab vBMD in children with type 1 diabetes in comparison with healthy controls and to assess the relationship of Trab vBMD with TBS. METHODS A total of 205 children were assessed for their LS bone mineral content (BMC) and LS aBMD by dual energy x-ray absorptiometry (DXA) and Trab vBMD at distal radius by peripheral quantitative computed tomography (pQCT). Machine generated Z-scores for both LS aBMD and Trab vBMD were used. The retrospective DXA LS scans in children with T1DM (n=137, age 13.1 ± 3.2 years) and controls (n = 68, age 13.0 ± 2.7 years) were analysed with a research trial version of TBS iNsight software (Medimaps Group). The established TBS cut-offs were used to categorize TBS. RESULTS The mean LS BMC, LS aBMD, TBS and Trab vBMDs were lower in children with T1DM. TBS was positively correlated with LS aBMD but not with Trab vBMD in both groups. Distribution of T1DM and control children was similar in the TBS categories. Over a fourth of the T1DM children with low Trab vBMD (below -2 Z score) had normal TBS, while, in children with LS aBMD Z-score > -2 from both groups, >50% had degraded or partially degraded TBS. Degraded TBS was seen in half the control children although none of them had low Trab vBMD. CONCLUSION We found poor correlation between TBS and Trab vBMD in paediatric diabetic and healthy population. Our results also suggest establishing paediatric TBS cut offs in improving the classification of children having degraded trabecular bone.
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Affiliation(s)
- Aditi Wagh
- Growth and Pediatric Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Veena Ekbote
- Growth and Pediatric Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Growth and Pediatric Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India; School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Growth and Pediatric Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India; School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.
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Dayal D, Gupta BM, Gupta S, Gupta A. Type 1 diabetes in children: a scientometric assessment of Indian research output from 1990 to 2019. Int J Diabetes Dev Ctries 2021; 41:404-11. [DOI: 10.1007/s13410-021-00919-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Sathyanarayana S. Recommendations to successfully implement the “National Registry and Surveillance for Children and Adolescents with type 1 diabetes in India”. J Diabetol 2021. [DOI: 10.4103/jod.jod_43_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
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Chiplonkar S, Kajale N, Lohiya N, Parthasarhty L, Khadilkar V, Khadilkar A. Dietary Patterns in Underprivileged Indian Children and Adolescents with Type 1 Diabetes. CNF 2020. [DOI: 10.2174/1573401315666191126091201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Children with diabetes are likely to have different food and nutrient composition
due to dietary restrictions. Studies on dietary intakes in Indian underprivileged children with
Type1 diabetes are scarce.
Objective:
To study dietary patterns and nutrient intakes of underprivileged children and adolescents
with type1 diabetes in comparison with their healthy siblings.
Methods:
Cross-sectional study, diet assessed by 24-h recall on 3-non-consecutive days in 120 children
with type1 diabetes (11.2 ± 3.8 yrs) and 65-age-gender matched healthy siblings. Dietary patterns
determined by cluster analysis. Nutrient composition was compared by one-way ANOVA.
Results:
Children with diabetes belonged to middle/lower economic class. Mean HbA1C of children
with diabetes was 9.7 ± 2.0% with higher intakes of whole cereals, milk, fruits, vegetables and lower
intakes of refined cereals, pulses, animal products than healthy siblings (P <0.05). Four diet patterns
were characterized on the basis of major foods: i) wheat, ii) millets, iii) rice and pulse and iv) milk
and fruits. Though patterns were similar in both groups, significantly higher intakes of vitamin C
(35 ± 23 vs. 24.7 ± 16.3 mg/d), zinc (5.6 ± 2 vs. 4.5 ± 2.3 mg/d), thiamin (812 ± 383 vs. 570 ± 254 μg/d),
riboflavin (782 ± 341 vs. 352 ± 182 μg/d) and calcium (673 ± 272 vs. 461 ± 253 mg/d) noted in children
with diabetes. Total energy, protein and carbohydrate intakes were comparable; fat consumption
was significantly lower amongst children with diabetes, though above recommended daily allowance
(RDA) 41.6 ± 14.1 gm vs. 47.4 ± 18.9 gm, P=0.029.
Conclusion:
Underprivileged children with diabetes and siblings had similar dietary patterns;
children with diabetes consumed healthier diet than siblings, still glycemic control was not optimum.
Dietary interventions are needed to improve micronutrient intake and reduce fat intake in underprivileged
children with type1 diabetes to improve their glycemic control.
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Affiliation(s)
- Shashi Chiplonkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Neha Kajale
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Nikhil Lohiya
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Lavanya Parthasarhty
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Vaman Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Anuradha Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
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Ramachandran A, Jain SM, Mukherjee S, Phatak S, Pitale S, Singh SK, Agrawal N, Majumdar A, Deshpande N, Jhulka S, Minakshisundaram S, Chawla M, Lodha S, Maheshwari A, Makkar BM, Rao S, Shah P, Ghosh R, Mohanasundaram S, Menon S, Chodankar D, Kanade V, Trivedi C. Suboptimal glycemic control among subjects with diabetes mellitus in India: a subset analysis of cross-sectional wave-7 (2016) data from the International Diabetes Management Practices Study (IDMPS). Ther Adv Endocrinol Metab 2020; 11:2042018820937217. [PMID: 32647562 PMCID: PMC7325532 DOI: 10.1177/2042018820937217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 05/03/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To assess the real-world management practices of subjects with type 2 diabetes mellitus (T2DM) and type 1 diabetes mellitus (T1DM) in India. METHODS This cross-sectional study was conducted between 7 March 2016 and 15 May 2016 in India as part of the seventh wave (2016) of the International Diabetes Management Practices Study (IDMPS). Adult subjects with T1DM or T2DM visiting physicians during a 2-week recruitment period were included. RESULTS A total of 55 physicians included 539 subjects who met eligibility criteria. Of 495 subjects with T2DM, 303 were treated with oral glucose lowering drugs (OGLDs) only, 158 were treated with OGLD + insulin, and 27 received insulin only. Among 44 subjects with T1DM receiving insulin, 13 (29.5%) were also treated with OGLD therapy. The most commonly used insulin regimens were basal alone (69/184; 37.5%) and premixed alone (63/184; 34.2%) in subjects with T2DM, and basal + prandial insulin (24/44; 54.5%) in subjects with T1DM. Proportions of subjects achieving glycemic targets were low [glycated haemoglobin (HbA1c) <7%: T1DM = 7.3% (3/44), T2DM = 25.2% (106/495); as targeted by the treating physician: T1DM = 31.8% (14/44), T2DM = 32.1% (59/185); global target: T1DM = 4.8% (2/42) and T2DM = 1.7% (8/482)]. In subjects with T2DM, HbA1c <7% was noted in 11/22 subjects receiving insulin only and 76/260 receiving only OGLDs. Lack of experience in self-managing insulin dosing, poor diabetes education and failure to titrate insulin dosages were the main reasons for non-achievement of glycemic targets. CONCLUSION Timely insulinization, education and empowerment of people with diabetes may help improve glycemic control in India.
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Affiliation(s)
- Ambady Ramachandran
- Department of Diabetology, Dr. Ramachandran’s Diabetes Hospital, No. 28, Marshall’s Road, Egmore, Chennai 600 008, India
| | - Sunil M. Jain
- Department of Endocrinology, TOTALL Diabetes Hormone Institute, Indore, India
| | - Sagarika Mukherjee
- Department of Diabetology, Dr. Sagarika Mukherjee’s Endocrinology Clinic, Kolkata, India
| | - Sanjeev Phatak
- Department of Diabetology, Vijayratna Diabetes Diagnosis and Treatment Centre, Ahmedabad, India
| | - Shailesh Pitale
- Department of Diabetology, Pitale Diabetes and Hormone Centre, Nagpur, India
| | - Shailendra K. Singh
- Department of Diabetology, Dr. Shailendra Kumar Singh’s Clinic, Varanasi, India
| | - Navneet Agrawal
- Department of Diabetology and Obesity, Diabetes, Obesity and Thyroid Centre, Gwalior, India
| | - Anirban Majumdar
- Department of Endocrinology, Anirban’s Diabetes- Obesity-Thyroid & Hormone Clinic, Kolkata, India
| | | | - Sandeep Jhulka
- Department of Diabetology, Radiance the Hormone Health Clinic, Indore, India
| | | | - Manoj Chawla
- Department of Diabetology, Lina Diabetes Care Centre and Mumbai Diabetes Research Centre, Mumbai, India
| | - Sailesh Lodha
- Department of Endocrinology, Dr. Sailesh Lodha Clinic, Rajasthan, India
| | - Anuj Maheshwari
- Department of Diabetology, Shri Hari Kamal Diabetes and Research Clinic, Lucknow, India
| | - Brij Mohan Makkar
- Department of Diabetology and Obesity, Diabetes and Obesity Centre, New Delhi, India
| | - Sadashiva Rao
- Department of Diabetology, Diabetic Care Centre, Vijayawada, India
| | - Parag Shah
- Department of Endocrinology, Gujarat Endocrine Centre, Ahmedabad, India
| | - Romik Ghosh
- Medical Affairs, Sanofi India Limited, Mumbai, Maharashtra, India
| | | | - Shalini Menon
- Medical Affairs, Sanofi India Limited, Mumbai, Maharashtra, India
| | - Deepa Chodankar
- Clinical Study Unit, Sanofi Synthelabo India Limited, Mumbai, Maharashtra, India
| | - Vaishali Kanade
- Clinical Study Unit, Sanofi Synthelabo India Limited, Mumbai, Maharashtra, India
| | - Chirag Trivedi
- Clinical Study Unit, Sanofi Synthelabo India Limited, Mumbai, Maharashtra, India
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Kochar I, Sethi A, Ramachandran S. Real-World Efficacy and Safety of Continuous Subcutaneous Insulin Infusion (CSII) Therapy and Comparison of Treatment Satisfaction between CSII and Multiple Daily Injection Therapy. Dubai Diabetes Endocrinol J 2020. [DOI: 10.1159/000507391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Objectives:</i></b> Type 1 diabetes mellitus (T1DM) is one of the most common pediatric endocrine diseases. India alone is home to around 97,700 children with T1DM. This paper evaluates the efficacy, safety, and quality of life with continuous subcutaneous insulin infusion (CSII) in patients treated for a protracted time period of 1 year in a retrospective study versus multiple-dose insulin (MDI). <b><i>Methods:</i></b> CSII was offered to patients with poor metabolic control (HbA1c >8.5%) on MDI, patients needing flexible timing of meals, or patients with hypoglycemia unawareness/nocturnal hypoglycemia/high blood sugar fluctuations. Continuous blood glucose monitoring (CGM) was done using the Medtronic CGM system gold/iPro 2 in all patients. Data were collected through a questionnaire completed by patients with the help of a pediatric endocrinologist. <b><i>Results:</i></b> A total of 45 patients completed the study evaluation period. The results demonstrated better glycemic control, reduced hypoglycemia on CGM, and no events of diabetic ketoacidosis noted on CSII. The hypoglycemic events were few and nonsevere. The patients in the CSII group reported better quality of life on the Pediatric Quality of Life Inventory 3.2 Diabetic Module diabetes score than the MDI group. <b><i>Conclusions:</i></b> This study is the first of this kind in India in the field of pediatric endocrinology. The clinical outcomes validate the use of CSII as the desirable intensive insulin therapy.
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Affiliation(s)
- Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal, India
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Esen I, Okdemir D. Trend of type 1 diabetes incidence in children between 2009 and 2019 in Elazig, Turkey. Pediatr Diabetes 2020; 21:460-465. [PMID: 31951309 DOI: 10.1111/pedi.12984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/09/2019] [Accepted: 01/13/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To assess the incidence of T1D in children aged <15 years in Elazig, Turkey. METHOD The data of children who have been registered as child with T1D in the database of pediatric diabetes clinic was analyzed. Childhood census data were acquired from the Turkish Statistical Institute. The incidence rates of T1D were calculated for the whole group as well as separately for age group, gender, year of diagnosis, and place of residence, viz. either urban or rural per 100 000 persons per year. The change of incidence during the 10 year observation period was analyzed. RESULTS The overall mean incidence of T1D in study period was 16.7/100 000 [95% confidence interval (CI): 14.6-19.0] persons per year. The incidence rates of T1D varied from 10.2 to 24.1/100 000 persons per year, representing 2.4-fold variation between 2009 and 2019. The lowest incidence rate was in children aged 0 to 4 years (9.6/100 000 persons per year; CI: 6.9-12.9). There was no difference in incidence rate between genders, incidence rates was significant higher in urban residents. A significant increasing trend of T1D was detected in the total 10-year observation period; the average annual percent change was 7.8%. Subgroup analysis showed that there was significant increasing trend in boys, urban residents, and children aged 5 to 9 years groups. CONCLUSION This study demonstrated increase in T1D incidence of in children in Elazig and highest regional incidence rate of T1D until now in Turkey compared to previous limited data.
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Affiliation(s)
- Ihsan Esen
- Department of Paediatric Endocrinology, Firat University Hospital, Elazig, Turkey
| | - Deniz Okdemir
- Department of Paediatric Endocrinology, Firat University Hospital, Elazig, Turkey
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Dongare-Bhor S, Lohiya N, Maheshwari A, Ekbote V, Chiplonkar S, Padidela R, Mughal Z, Khadilkar V, Khadilkar A. Muscle and bone parameters in underprivileged Indian children and adolescents with T1DM. Bone 2020; 130:115074. [PMID: 31626994 DOI: 10.1016/j.bone.2019.115074] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/13/2019] [Accepted: 09/17/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The incidence of Type 1 diabetes mellitus (T1DM) is increasing and sarcopenia and osteoporosis have been reported to be associated with long standing diabetes. There is scarcity of data on bone health status of children with T1DM. Our aim was to assess bone health parameters [by Dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT)] and muscle strength (by hand grip) in underprivileged Indian children with T1DM. MATERIAL AND METHODS A cross sectional, observational study was conducted in underprivileged children with diabetes attending the out patient clinic for T1DM at a tertiary care hospital. Children with T1DM with disease duration more than 1 year were included in the study. Age and gender matched controls were also enrolled. Data on age, gender, disease duration, anthropometric parameters and HbA1c were collected. Bone mineral density (BMD) was assessed by dual energy X-ray absorptiometry (Lunar iDXA) and peripheral quantitative computed tomography (pQCT, Stratec XCT 2000) and muscle strength by handgrip. Data were analysed using SPSS 25.0. RESULTS 251 children with T1DM and 250 age gender matched controls were studied. Mean age of T1DM children was 10.8 ± 4.3yrs (controls 10.3 ± 3.6). Mean HbA1C was 9.7 ± 2.1%. The total body less head areal BMD (TBLH aBMD) and lumbar spine bone mineral apparent density (LSBMAD) Z-scores were significantly lower in children with T1DM (-1.5 ± 1.3, -1.3 ± 1.6 respectively) as compared to controls (-0.5 ± 1.3, -0.64 ± 1.5 respectively) (p < 0.05 for both). Z-scores for trabecular and total density (vBMD) were significantly lower in patients with T1DM (-0.7 ± 1.0, -0.7 ± 1.0 respectively) than controls (-0.15 ± 1.2, -0.31 ± 1.1), (p < 0.05) and trabecular density was lower at distal radius with increasing disease duration. Hand-grip strength Z-score was lower in children with T1DM (-3.0 ± 0.5) as compared to controls (-2.8 ± 0.5). Trabecular density and HbA1C concentrations were negatively correlated (R = -0.18, p < 0.05) as was muscle area and HbA1C concentrations (R = -0.17, p < 0.05,). CONCLUSION Bone and muscle health were affected in children with poorly controlled T1DM. With increasing disease duration, attention is required for optimising musculoskeletal health.
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Affiliation(s)
- Shital Dongare-Bhor
- Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India.
| | - Nikhil Lohiya
- Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India.
| | - Ankita Maheshwari
- Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India.
| | - Veena Ekbote
- Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India.
| | - Shashi Chiplonkar
- Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India.
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK; Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Zulf Mughal
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK; Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Vaman Khadilkar
- Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India.
| | - Anuradha Khadilkar
- Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India.
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Pramanik BK, Angelin JJ, Mathai VJ, Mathai S, Korula S, Simon A. Smartphone App as Motivational Intervention to Improve Glycemic Control in Adolescents with Type 1 Diabetes. Indian J Pediatr 2019; 86:1118-23. [PMID: 31353430 DOI: 10.1007/s12098-019-03035-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 07/08/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Type 1 diabetes (T1D) adolescents often do not achieve good glycemic control. In the context of growing number of technologically savvy adolescents, this study was done to examine the effectiveness of a motivational smartphone app to improve their glycemic control. METHODS Eleven to eighteen year old adolescents, treated by Pediatric endocrine team of CMC, Vellore, who had T1D ≥ 1 y duration with poor glycemic control (mean HbA1c ≥ 8.5% in preceding 12 mo) were recruited. An app programmed to provide 3 reminders per day regarding insulin, meals and physical exercise was installed on their phone. Diabetes management was continued as per the standard of care. HbA1C was measured after 3 mo. RESULTS Thirty seven adolescents were recruited; 3 were excluded as the app became non-functional. Seventeen were boys, mean age was 13.8 y (11-18 y) and mean duration of diabetes was 4.9 y (0.8-16 y). The mean HbA1c levels over preceding 12 mo and at recruitment were 10.75% (1.88) and 10.6% (2.08) respectively. Twenty eight participants returned for repeat HbA1C after 3-4 mo. As compared to baseline there was significant reduction in HbA1c level: 10.6% (2.08) vs. 9.65% (1.6); p = 0.004. Twenty two of twenty eight participants showed reduction in HbA1c after app installation. The magnitude of change in HbA1c levels over a 3 mo period before and after the app use was analyzed. There was significant difference between mean HbA1c levels before and after app use; +0.28 (2.06) vs. -0.914 (1.52); p = 0.019. CONCLUSIONS Following usage of smartphone app as a motivational intervention in adolescents with Type 1 diabetes, there was significant reduction in HbA1c level after 3 mo. With continued use, this may benefit them to achieve target HbA1c levels. Use of mobile phone apps as motivational interventions is feasible in adolescents with Type 1 diabetes in India.
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Abstract
Background In spite of the large number of people with Type-1 diabetes mellitus (T1DM) in India, India is not a diabetes-friendly society. The society suffers from lots of myths regarding diabetes and insulin use. This review highlights challenges faced by young people living with T1DM with regards to marriage, associated diabetes distress, and suggests potential solutions. Methods PubMed, Medline, and Embase search for articles published up to October 2017, using the terms "marriage" (MeSH Terms) OR "diabetes distress" (All Fields) OR "depression" (All Fields) AND "diabetes" (All Fields). The reference lists of the articles thus identified were also searched. The search was not restricted to English-language literature. Results Misconception regarding social, occupational, marital abilities, fertility, genetics, quality of life, sexism in young people living with T1DM raises major barriers to marriage, resulting in significant diabetes distress, depression, and psychological issues in them. People with T1DM are wrongly assumed to be sick, disabled, dependent persons, unsuitable for marriages, and likely to have complicated pregnancies with the possibility of having children with diabetes. Counseling at the level of individual, spouse, family, and society can help in obviating such issues. Conclusion Diabetes distress and psychological issues are major problems related to marriage in young people with T1DM. Counseling of patients, family, relatives, prospective spouse, and increasing social awareness regarding diabetes through mass communication are the keys to their resolution.
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Affiliation(s)
- Deepak Khandelwal
- Department of Endocrinology and Diabetes, Maharaja Agrasen Hospital, Punjabi Bagh, New Delhi, India
| | - Lovely Gupta
- Department of Food and Nutrition, Lady Irwin College, Delhi University, New Delhi, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Amit Vishwakarma
- Society for the Promotion of Education in Endocrinology and Diabetes, Dwarka, New Delhi, India
| | - Priti Rishi Lal
- Department of Food and Nutrition, Lady Irwin College, Delhi University, New Delhi, India
| | - Deep Dutta
- Department of Endocrinology, Diabetes and Metabolism, Venkateshwar Hospital, New Delhi, India
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Babu KLG, Subramaniam P, Kaje K. Assessment of dental caries and gingival status among a group of type 1 diabetes mellitus and healthy children of South India - a comparative study. J Pediatr Endocrinol Metab 2018; 31:1305-1310. [PMID: 30465719 DOI: 10.1515/jpem-2018-0335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/29/2018] [Indexed: 11/15/2022]
Abstract
Background Diabetes mellitus is a metabolic disorder. However, dental caries and periodontal health have not attracted much interest in diabetic patients. This study was carried out to assess the dental caries status and gingival health status in children with type 1 diabetes mellitus (T1DM). Methods The study group consisted of 80 children, aged 6-18 years, with T1DM. The dental caries status was recorded using the World Health Organisation (WHO) criteria. Gingival health was assessed using the Loe and Silness gingival index (GI). Data obtained were subjected to statistical analysis. Results The mean dental caries status for primary (decayed, extracted, filled teeth [deft]) and permanent dentition (decayed, missing, filled teeth [DMFT]) scores in diabetic children were 0.44±1.28 and 1.26±2.49, respectively. The GI scores of diabetic children were 0.33±0.48. GI in the study group significantly correlated with DMFT (p<0.001) and deft (p≤0.05). Conclusions Dental caries in primary dentition was lower in diabetic children but was not statistically significant, whereas dental caries in permanent dentition was significantly higher. The gingival condition of diabetic children was healthy.
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Affiliation(s)
- K L Girish Babu
- Department of Dentistry, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
| | - Priya Subramaniam
- Department of Pedodontics and Preventive Dentistry, The Oxford Dental College, Hospital and Research Centre, Bangalore, Karnataka, India
| | - Keerthan Kaje
- Department of Pedodontics and Preventive Dentistry, The Oxford Dental College, Hospital and Research Centre, Bangalore, Karnataka, India
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Abstract
This review describes the epidemiology of childhood diabetes in India. It focuses on the incidence and prevalence of type 1 diabetes and its complications and comorbid conditions. The review also covers data related to type 2 diabetes, glucose intolerance, and monogenic diabetes from India. A brief discussion regarding unique contributions from India to the world literature is included. The topics discussed include use of camel milk as adjuvant therapy in type 1 diabetes, relevance of the A1/A2 hypothesis, and comprehensive clinico-etiopathological classification of type 1 diabetes.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India,Address for correspondence: Sanjay Kalra, MD, DM Department of Endocrinology, Bharti Hospital Kunjpura Road, Karnal 132001, India Tel: +91-9896048555 Fax: +91-1844046554 E-mail:
| | - Mudita Dhingra
- Department of Pediatric Endocrinology, Radha Kishan Hospital, Kurukshetra, India
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Kochar IS, Sethi A. Real-world efficacy and safety of insulin degludec with mealtime rapid-acting insulin in type 1 diabetes in Indian pediatric population. Int J Pediatr Endocrinol 2018; 2018:6. [PMID: 30069184 PMCID: PMC6064114 DOI: 10.1186/s13633-018-0059-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/09/2018] [Indexed: 11/10/2022]
Abstract
Background Insulin Degludec (IDeg) is a new ultra-long-acting basal insulin that has not been yet evaluated in Indian pediatric population. We aim to evaluate the efficacy and safety of IDeg as basal-bolus therapy in Indian pediatric patients affected by type 1 diabetes mellitus (T1DM). Methods A total of 30 pediatric and adolescent patients (17 boys, 13 girls; 22 were pre-pubertal) with T1DM who were on IDeg once daily participated in the study. All the patients received IDeg for at least 26 weeks along with rapid-acting mealtime insulin and their pre- and post-baseline characteristics (anthropometric data (BMI), age, duration of diabetes), metabolic (HbA1C), insulin requirement (unit/kg body weight per day) and number of hypoglycemia episodes were recorded along with the daily self-monitoring of blood glucose. Results There was a significant decline in HbA1c, FPG and bolus insulin dose from baseline to 26 weeks in the overall population (HbA1c: 9.65 ± 1.998% to 8.60 ± 1.631%, P = 0.0014; FPG: 156.93 ± 42.373 mg/dL to 109.37 ± 28.531 mg/dL, P = 0.000004; bolus insulin dose: 0.49 ± 0.208 U/kg/day to 0.35 ± 0.155 U/kg/day, P = 0.00032). The basal insulin dose was significantly higher at 26 weeks compared to baseline dose (0.42 ± 0.134 U/kg/day to 0.46 ± 0.139 U/kg/day, P = 0.04219). There was no significant change in BMI at 26 weeks.None of the patients experienced any DKA episode for 26 weeks. 16.7% patients had experienced at least one symptomatic hypoglycemia episode. On CGMS among the patients who were shifted from Glargine to degludec hypoglycemia were reduced significantly (overall hypoglycemia: 1.92 ± 1.26 to 0.35 ± 0.49 episodes over 3 days, P = 0.0026 while nocturnal hypoglycemia: 0.92 ± 0.47 to 0.21 ± 0.42 episodes, P = 0.0021). None of the patients had severe hypoglycemia episode. Conclusion In our study IDeg is found to be safe and effective long-acting basal insulin that can be used in Indian pediatric population with T1DM. However further long term prospective studies are required to evaluate the long term effects.
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Kumar KVSH, Patnaik SK. A long term follow-up study from India assessing the risk of diabetes mellitus in service population. Diabetes Metab Syndr 2018; 12:87-90. [PMID: 28951061 DOI: 10.1016/j.dsx.2017.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 09/20/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The data about the incidence of diabetes is scarce from developing countries. We studied the incidence of type 1 (T1DM) and type 2 DM (T2DM) in a cohort of young military personnel followed for a long duration. METHODS The data for this descriptive epidemiologic study was derived from the electronic medical records (EMR) of the male service personnel enrolled between 1990 and 2015. All subjects were recruited before 18 years of age in good health and the onset of DM was derived from the EMR. We calculated the incidence rates as per person years using appropriate statistical methods. RESULTS Our study population includes 51,217 participants (median age 33 years, range 17-54) with a mean follow up of 12.5 years, giving a cumulative follow up duration of 613,925 person-years (py). A total of 251 patients developed T2DM and 15 patients developed T1DM during the study period. The incidence rate of T2DM was 0.41 per 1000 py and that of T1DM was 2.44 per 100,000 py. CONCLUSION Our cohort had low incidence rates of diabetes when compared with other studies from India and abroad. Active military service with good life style measures may offer protection from the DM.
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Affiliation(s)
- K V S Hari Kumar
- Departments of Endocrinology & Pediatrics, Army Hospital (Research & Referral), Delhi, 110010, India.
| | - S K Patnaik
- Departments of Endocrinology & Pediatrics, Army Hospital (Research & Referral), Delhi, 110010, India
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Szalecki M, Wysocka-Mincewicz M, Ramotowska A, Mazur A, Lisowicz L, Beń-Skowronek I, Sieniawska J, Klonowska B, Charemska D, Nawrotek J, Jałowiec I, Bossowski A, Jamiołkowska M, Pyrżak B, Miszkurka G, Szypowska A. Epidemiology of type 1 diabetes in Polish children: A multicentre cohort study. Diabetes Metab Res Rev 2018; 34. [PMID: 29144024 DOI: 10.1002/dmrr.2962] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 10/05/2017] [Accepted: 10/14/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND The incidence of childhood type 1 diabetes (T1D) varies greatly between populations, and the estimates and/or predictions of the rates would aid in adequate planning of health care resources. The study's aim was to assess the incidence of T1D in the paediatric population of eastern and central Poland. METHODS In this cohort study covering the period from January 2010 to December 2014, data were collected for children and adolescents below 18 years of age with newly diagnosed T1D living in eastern and central Poland. A total of 2174 children were included in the analysis. The population estimates were from the Central Statistical Office of Poland. RESULTS Overall, the annual incidence of T1D increased from 12.84/100,000 in 2010 to 18.46/100,000 in 2014 with the incidence rate (IR) ratio of 1.5 (an increase in the IR by 12.7% per year over 5 years). The lowest increase in the IR by 7.1% per year was seen in 15 to 17-year-olds. In the urban population (age 0-17 years), the overall incidence rate was significantly higher than in subjects from rural communities (P < .02). The incidence of T1D in rural areas was significantly higher (p = .004) in voivodeships of higher population density. Such dependence was not observed in urban areas. CONCLUSIONS The incidence of T1D in children living in eastern and central Poland increased 1.5-fold over the 5-year observation period with the highest rise in 10 to 14-year-olds and significantly higher rates in urban children compared with their peers living in rural areas.
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Affiliation(s)
- Mieczysław Szalecki
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland
- The Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Marta Wysocka-Mincewicz
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland
| | - Anna Ramotowska
- Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Artur Mazur
- II Department of Paediatrics, Paediatric Endocrinology and Diabetes, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - Lucyna Lisowicz
- II Department of Paediatrics, Paediatric Endocrinology and Diabetes, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - Iwona Beń-Skowronek
- Department of Paediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland
| | - Joanna Sieniawska
- Department of Paediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland
| | - Bożena Klonowska
- Department of Clinical Paediatrics, Faculty of Medical Sciences, Provincial Specialist Children's Hospital, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Dorota Charemska
- Department of Clinical Paediatrics, Faculty of Medical Sciences, Provincial Specialist Children's Hospital, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Jolanta Nawrotek
- Endocrinology and Diabetology Ward, General District Hospital, Kielce, Poland
| | - Irena Jałowiec
- Endocrinology and Diabetology Ward, General District Hospital, Kielce, Poland
| | - Artur Bossowski
- Department of Paediatrics, Endocrinology and Diabetology with a Cardiology Division, Medical University of Białystok, Białystok, Poland
| | - Milena Jamiołkowska
- Department of Paediatrics, Endocrinology and Diabetology with a Cardiology Division, Medical University of Białystok, Białystok, Poland
| | - Beata Pyrżak
- Department of Paediatric Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Grażyna Miszkurka
- Department of Paediatric Endocrinology, Medical University of Warsaw, Warsaw, Poland
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Abstract
BACKGROUND The comprehensive epidemiology of endocrine disorders is lacking from our country. Most of the available data pertain to the prevalence of diabetes and thyroid disorders only. We studied the incidence of endocrine disorders in a cohort of service personnel followed for a long duration. MATERIALS AND METHODS The data for this descriptive epidemiologic study were derived from the electronic medical records of the male service personnel enrolled between 1990 and 2015. They were recruited between the ages of 17 and 20 years in good health, and their morbidity data were derived from the medical records. We calculated the incidence rates as per person-years (py) using appropriate statistical methods. RESULTS Our analysis includes 51,217 participants (median: age 33 years, range: 17-54) with a mean follow-up of 12.5 years. Yearly evaluation of the data gave a cumulative follow-up duration of 613,925 py. The incidence of diabetes, obesity, and dyslipidemia was 0.41, 0.23, and 0.12 per 1000 py, respectively. The incidence of thyroid, parathyroid, pituitary, adrenal, and metabolic bone disorders was 3.9, 8.6, 1.6, 0.81, and 0.97 per 100,000 py, respectively. CONCLUSION Our cohort had lower incidence rates of endocrine disorders when compared with the Western population. Long-term epidemiological studies are essential to identify the demographic trends of the endocrine disorders in India.
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Affiliation(s)
- K. V. S. H Kumar
- Department of Endocrinology, Army Hospital (Research and Referral), New Delhi, India
| | - S. K. Patnaik
- Department of Pediatrics, Army Hospital (Research and Referral), New Delhi, India
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33
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Chen YL, Huang YC, Qiao YC, Ling W, Pan YH, Geng LJ, Xiao JL, Zhang XX, Zhao HL. Climates on incidence of childhood type 1 diabetes mellitus in 72 countries. Sci Rep 2017; 7:12810. [PMID: 28993655 PMCID: PMC5634499 DOI: 10.1038/s41598-017-12954-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/12/2017] [Indexed: 12/25/2022] Open
Abstract
We are aimed to systematically assess the worldwide trend in incidence of childhood type 1 diabetes mellitus (CT1DM) from 1965 to 2012 and to discuss whether climate affect incidence of CT1DM. We searched the relevant literatures in detail to judge the effect of different climates on incidence of CT1DM. The climates included Mediterranean, monsoon, oceanic, continental, savanna, and rainforest. According to different climates, we further researched relevant factor such as sunshine durations and latitudes. The overall incidence of CT1DM in 72 countries was 11.43 (95% CI 10.31–12.55) per 100,000 children/yr. The incidence of CT1DM in Oceanic climate [10.56 (8.69–12.42)] is highest compared with other climates; the incidence in 40°–66°34′N/S [14.71 (12.30–17.29)] is higher than other latitude groups; the incidence in sunshine durations with 3–4 hours per day [15.17 (11.14–19.20)] is highest compared with other two groups; the incidence of CT1DM from 2000 to 2012 [19.58 (14.55–24.60)] is higher than other periods; all p < 0.01. Incidence of CT1DM was increasing from 1965 to 2012, but incidence in Oceanic climate is higher than other climates. Furthermore, it is higher in centers with higher latitude and lower sunshine durations. The climates might play a key role in inducing CT1DM.
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Affiliation(s)
- Yin-Ling Chen
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Yong-Cheng Huang
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China
| | - Yong-Chao Qiao
- Department of Immunology, Xiangya School of Medicine, Central South University, Changsha, Hunan, 410078, China
| | - Wei Ling
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China
| | - Yan-Hong Pan
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Li-Jun Geng
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Jian-Long Xiao
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Xiao-Xi Zhang
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China. .,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China.
| | - Hai-Lu Zhao
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China. .,Department of Immunology, Xiangya School of Medicine, Central South University, Changsha, Hunan, 410078, China. .,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China.
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Kumar S, Patial V, Soni S, Sharma S, Pratap K, Kumar D, Padwad Y. Picrorhiza kurroa Enhances β-Cell Mass Proliferation and Insulin Secretion in Streptozotocin Evoked β-Cell Damage in Rats. Front Pharmacol 2017; 8:537. [PMID: 28878669 PMCID: PMC5572391 DOI: 10.3389/fphar.2017.00537] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/02/2017] [Indexed: 12/26/2022] Open
Abstract
Autoimmune destruction of insulin producing pancreatic β-cells leads to insulin insufficiency and hyperglycemia in type 1 diabetes mellitus. Regeneration of β-cells is one of the proposed treatment for type 1 diabetes and insulin insufficiency. Picrorhiza kurroa is a medicinal herb and is traditionally being used for the treatment of various diseases. Previous studies reported the hypoglycemic potential of P. kurroa. However, its potential role in β-cell induction in insulin secretion have not been fully investigated. Here, we characterized the hydro alcoholic extract of P. kurroa rhizome (PKRE) and further studied its β-cell regeneration and induction of insulin secretion potential in streptozotocin (STZ) induced diabetic rats as well as in insulin producing Rin5f cells. 1H-NMR revealed the presence of more than thirty metabolites including picroside I and II in PKRE. Further, we found that PKRE treatment (100 and 200 mg/kg dose for 30 days) significantly (p ≤ 0.05) protected the pancreatic β-cells against streptozotocin (STZ) evoked damage and inhibited the glucagon receptor expression (Gcgr) in hepatic and renal tissues. It significantly (p ≤ 0.05) enhanced the insulin expression and aids in proliferation of insulin producing Rin5f cells with elevated insulin secretion. Furthermore it significantly (p ≤ 0.05) increased insulin mediated glucose uptake in 3T3L1 and L6 cells. On the contrary, in diabetic rats, PKRE significantly (p ≤ 0.05) decreased high blood glucose and restored the normal levels of serum biochemicals. Altogether, our results showed that PKRE displayed β-cell regeneration with enhanced insulin production and antihyperglycemic effects. PKRE also improves hepatic and renal functions against oxidative damage.
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Affiliation(s)
- Shiv Kumar
- Pharmacology and Toxicology Lab, Food and Nutraceuticals Division, CSIR-Institute of Himalayan Bioresource TechnologyPalampur, India.,Academy of Scientific and Innovative ResearchNew Delhi, India
| | - Vikram Patial
- Pharmacology and Toxicology Lab, Food and Nutraceuticals Division, CSIR-Institute of Himalayan Bioresource TechnologyPalampur, India.,Academy of Scientific and Innovative ResearchNew Delhi, India
| | - Sourabh Soni
- Pharmacology and Toxicology Lab, Food and Nutraceuticals Division, CSIR-Institute of Himalayan Bioresource TechnologyPalampur, India.,Academy of Scientific and Innovative ResearchNew Delhi, India
| | - Supriya Sharma
- Pharmacology and Toxicology Lab, Food and Nutraceuticals Division, CSIR-Institute of Himalayan Bioresource TechnologyPalampur, India.,Academy of Scientific and Innovative ResearchNew Delhi, India
| | - Kunal Pratap
- Pharmacology and Toxicology Lab, Food and Nutraceuticals Division, CSIR-Institute of Himalayan Bioresource TechnologyPalampur, India
| | - Dinesh Kumar
- Academy of Scientific and Innovative ResearchNew Delhi, India.,Natural Product Chemistry and Process Development Division, CSIR-Institute of Himalayan Bioresource TechnologyPalampur, India
| | - Yogendra Padwad
- Pharmacology and Toxicology Lab, Food and Nutraceuticals Division, CSIR-Institute of Himalayan Bioresource TechnologyPalampur, India.,Academy of Scientific and Innovative ResearchNew Delhi, India
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Affiliation(s)
- Ram K Menon
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, USA
| | - Inas H Thomas
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, USA
| | - Mark A Sperling
- Department of Pediatrics, University of Pittsburgh, Pittsburgh; Department of Pediatrics, Mount Sinai School of Medicine, New York, USA
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36
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Kumar S, Singh S, Kenwar DB, Rathi M, Bhadada S, Sharma A, Gupta V, Bhansali A, Lal A, Minz M. Management of Graft Duodenal Leak in Simultaneous Pancreas Kidney Transplant-a Case Report from India and Review of Literature. Indian J Surg 2016; 78:402-406. [PMID: 27994337 DOI: 10.1007/s12262-016-1548-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/14/2016] [Indexed: 11/30/2022] Open
Abstract
Pancreatic transplantation is currently the only effective cure for Type 1 diabetes mellitus. It allows long-term glycemic control without exogenous insulin and amelioration of secondary diabetic complications. In India, pancreas transplant has not yet established with only a single successful transplant reported so far in the literature. We report a 24-year-old Type 1 diabetic patient with renal failure who underwent a simultaneous pancreas kidney transplant. On postoperative day 15, he had leak from the graft duodenal stump for which a tube duodenostomy and proximal diversion enterostomy was done. He had a high output pancreatic fistula following the procedure which was managed conservatively. The tube duodenostomy was removed at three and half months and enterostomy closure with restoration of bowel continuity was done at 6 months. After a follow up of 7 months, patient is doing well with a serum creatinine of 0.8 mg/dl and normal blood sugars, not requiring any exogenous insulin or oral hypoglycemic drugs. Managing patients with graft duodenal complications after pancreas transplant is challenging. Tube duodenostomy is a safe option in management of duodenal leak, although can lead to a persistent pancreatic fistula. A proximal diversion enterostomy allows early oral feeding and avoids the cost as well as the long term complications associated with parenteral nutrition.
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Affiliation(s)
- Sunil Kumar
- Department of Renal Transplant Surgery, Post graduate institute of medical education and research, Chandigarh, 160012 India
| | - Sarbpreet Singh
- Department of Renal Transplant Surgery, Post graduate institute of medical education and research, Chandigarh, 160012 India
| | - Deepesh Benjamin Kenwar
- Department of Renal Transplant Surgery, Post graduate institute of medical education and research, Chandigarh, 160012 India
| | - Manish Rathi
- Department of Nephrology, Post graduate institute of medical education and research, Chandigarh, 160012 India
| | - Sanjay Bhadada
- Department of Endocrinology, Post graduate institute of medical education and research, Chandigarh, 160012 India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, Post graduate institute of medical education and research, Chandigarh, 160012 India
| | - Vikas Gupta
- Department of General Surgery, Post graduate institute of medical education and research, Chandigarh, 160012 India
| | - Anil Bhansali
- Department of Endocrinology, Post graduate institute of medical education and research, Chandigarh, 160012 India
| | - Anupam Lal
- Department of Radiodiagnosis, Post graduate institute of medical education and research, Chandigarh, 160012 India
| | - Mukut Minz
- Department of Renal Transplant Surgery, Post graduate institute of medical education and research, Chandigarh, 160012 India
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Bahadoran Z, Ghasemi A, Mirmiran P, Azizi F, Hadaegh F. Nitrate-nitrite-nitrosamines exposure and the risk of type 1 diabetes: A review of current data. World J Diabetes 2016; 7:433-440. [PMID: 27795817 PMCID: PMC5065663 DOI: 10.4239/wjd.v7.i18.433] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/30/2016] [Accepted: 08/16/2016] [Indexed: 02/05/2023] Open
Abstract
The potential toxic effects of nitrate-nitrite-nitrosamine on pancreatic β cell have remained a controversial issue over the past two decades. In this study, we reviewed epidemiological studies investigated the associations between nitrate-nitrite-nitrosamines exposure, from both diet and drinking water to ascertain whether these compounds may contribute to development of type 1 diabetes. To identify relevant studies, a systematic search strategy of PubMed, Scopus, and Science Direct was conducted using queries including the key words “nitrate”, “nitrite”, “nitrosamine” with “type 1 diabetes” or “insulin dependent diabetes mellitus”. All searches were limited to studies published in English. Ecologic surveys, case-control and cohort studies have indicated conflicting results in relation to nitrate-nitrite exposure from drinking water and the risk of type 1 diabetes. A null, sometimes even negative association has been mainly reported in regions with a mean nitrate levels < 25 mg/L in drinking water, while increased risk of type 1 diabetes was observed in those with a maximum nitrate levels > 40-80 mg/L. Limited data are available regarding the potential diabetogenic effect of nitrite from drinking water, although there is evidence indicating dietary nitrite could be a risk factor for development of type 1 diabetes, an effect however that seems to be significant in a higher range of acceptable limit for nitrate/nitrite. Current data regarding dietary exposure of nitrosamine and development of type 1 diabetes is also inconsistent. Considering to an increasing trend of type 1 diabetes mellitus (T1DM) along with an elevated nitrate-nitrite exposure, additional research is critical to clarify potential harmful effects of nitrate-nitrite-nitrosamine exposure on β-cell autoimmunity and the risk of T1DM.
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Butalia S, Kaplan GG, Khokhar B, Rabi DM. Environmental Risk Factors and Type 1 Diabetes: Past, Present, and Future. Can J Diabetes 2016; 40:586-593. [PMID: 27545597 DOI: 10.1016/j.jcjd.2016.05.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/08/2016] [Accepted: 05/03/2016] [Indexed: 02/06/2023]
Abstract
Type 1 diabetes is an autoimmune condition that results from the destruction of the insulin-producing beta cells of the pancreas. The excess morbidity and mortality resulting from its complications, coupled with its increasing incidence, emphasize the importance of better understanding the causes of this condition. Over the past several decades, a substantive amount of work has been done and, although many advances have occurred in identifying disease-susceptibility genes, there has been a lag in understanding the environmental triggers. Several putative environmental risk factors have been proposed, including infections, dietary factors, air pollution, vaccines, location of residence, family environment and stress. However, most of these factors have been inconclusive, thus supporting the need for further study into the causes of type 1 diabetes.
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Affiliation(s)
- Sonia Butalia
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Gilaad G Kaplan
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bushra Khokhar
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Doreen M Rabi
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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