Early Occurrence Cases of Diabetes Mellitus: Clinical Picture in Two Major Tertiary Care Hospitals in India

Author(s): Nitin Joseph*, Shreya Sharma, Vinisha Modi, Sanath Manjunatha, Saad A. Siddiqui, Mihika Sinha

Journal Name: Current Diabetes Reviews

Volume 15 , Issue 2 , 2019

Become EABM
Become Reviewer
Call for Editor


Introduction: Type 1 diabetes mellitus (T1D) is one of the most common endocrine diseases in childhood. However, very limited information is available on this disease.

Objectives: This study was done to assess risk factors, clinical features and management practices in T1D patients.

Methods: A review of records of 39 T1D cases admitted over the past five years in two hospitals was done.

Results: The mean age at diagnosis among males (n=21) was 19.9±10.3 years and among females (n=18) was 12.3±7.5 years (t=2.614, p=0.013). Mean age at diagnosis of patients who were underweight (n=7) was 9.9±4.4 years, compared to 17.8±10.1 years among patients (n=32) with normal or overweight status (t=2.028, p=0.05). The family history of T1D was present among 7(18.0%) cases. The most common symptoms among the cases were fatigue 22(56.4%), polyuria 19(48.7%) and polydipsia 18(46.1%). The most common sign was weight loss 27(69.2%). The most common complications were diabetic nephropathy and skin infections seen each among 10(25.6%) cases. Mean duration of T1D was significantly more among patients with diabetic nephropathy (p<0.001), compared to those without. Mean HbA1c value among patients was 12.9±2.7. It was significantly more among patients with Diabetic Ketoacidosis (DKA) (p=0.012). A short-acting insulin was used in the management of T1D among 59.5% cases. The outcome of the management showed a loss of one patient who developed DKA.

Conclusion: Routine growth monitoring and blood glucose analysis is required among T1D cases. The present study provides a database of risk factors, clinical features, and management practices among patients with T1D in this region and addresses several issues important to both patients and their care providers.

Keywords: Clinical features, complications, management, nutritional status, risk factors, type 1 diabetes mellitus.

Silverstein J, Klingensmith G, Copeland K, et al. Care of children and adolescents with type 1 diabetes: A statement of the American Diabetes Association. Diabetes Care 2005; 28: 186-212.
Kumar KM, Azad K, Zabeen B, Kalra S. Type 1 diabetes in children: Fighting for a place under the sun. Indian J Endocrinol Metab 2012; 16(Suppl. 1): S1-3.
Knip M, Siljander H. Autoimmune mechanisms in type 1 diabetes. Autoimmun Rev 2008; 7: 550-7.
Rawshani A, Landin-Olsson M, Svensson AM, et al. The incidence of diabetes among 0–34 year olds in Sweden: New data and better methods. Diabetologia 2014; 57: 1375-81.
Patterson C, Guariguata L, Dahlquist G, Soltész G, Ogle G, Silink M. Diabetes in the young - A global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes Res Clin Pract 2014; 103: 161-75.
International Diabetes Federation Diabetes Atlas. 5th ed. Brussels: IDF 2011.
Mythili A, Kumar DK, Vivekananda B, Subrahmanyam KAV. Clinical profile of type 1 diabetes mellitus in a tertiary care hospital. Int J Diabetes Dev Ctries 2016; 36: 146-9.
Children with type 1 diabetes at five-fold risk of hospitalisation [Internet]. Cardiff University; 2015 [Cited on: 8th Sep 2016]. Available from. http://www.cardiff.ac.uk/news/view/93005-children-with-type-1-diabetes-at-fivefold-risk-of-hospitalisation
Fazeli FS, Souverein PC, van der Vorst MM, Knibbe CA, de Boer A, Mantel-Teeuwisse AK. Chronic comorbidities in children with type 1 diabetes: a population based cohort study. Arch Dis Child 2015; 100: 763-8.
Markowitz JT, Garvey KC, Laffel LM. Developmental changes in the roles of patients and families in type 1 diabetes management. Curr Diabetes Rev 2015; 11: 231-8.
Kamal Alanani NM, Alsulaimani AA. Epidemiological pattern of newly diagnosed children with type 1 diabetes mellitus, Taif, Saudi Arabia. Sci World J 2013; 2013: 421569.
Alves C, Santos LS, Toralles MP. Association of type 1 diabetes mellitus and autoimmune disorders in Brazilian children and adolescents. Indian J Endocrinol Metab 2016; 20: 381-6.
Stene LC, Magnus P, Lie RT, Sovik O, Joner G. Norwegian childhood Diabetes Study Group. Birth weight and childhood onset type 1 diabetes: Population based cohort study. BMJ 2001; 322: 889-92.
Billow A, Anjana RM, Ngai M, et al. Prevalence and clinical profile of metabolic syndrome among type 1 diabetes mellitus patients in southern India. J Diabetes Complications 2015; 29: 659-64.
Daga RA, Naik SA, Maqbool M, Laway BA, Shakir M, Rafiq W. Demographic and Clinical Characteristics of Diabetes Mellitus among Youth Kashmir, India. Int J Pediatr 2015; 3: 739-47.
Dhanwal DK, Agarwal S, Garg S, Agarwal P, Singh V. Clinical & immunological profile of newly diagnosed patients with youth onset diabetes mellitus. Indian J Med Res 2014; 140: 356-60.
Khadilkar VV, Parthasarathy LS, Mallade BB, Khadilkar AV, Chiplonkar SA, Borade AB. Growth status of children and adolescents with type 1 diabetes mellitus. Indian J Endocrinol Metab 2013; 17: 1057-60.
Danne T, Kordonouri O, Enders I, Weber B. Factors influencing height and weight development in children with diabetes. Results of the berlin retinopathy study. Diabetes Care 1997; 20: 281-5.
Xu Y, Bai J, Wang G, et al. Clinical profile of diabetic ketoacidosis in tertiary hospitals in China: A multicentre, clinic-based study. Diabet Med 2016; 33: 261-8.
Roche EF, Menon A, Gill D, Hoey H. Clinical presentation of type 1 diabetes. Pediatr Diabetes 2005; 6: 75-8.
Tahirovic H, Toromanovic A, Bacaj D, Hasanovic E. Ketoacidosis at onset of type 1 diabetes mellitus in children in Bosnia and Herzegovina: frequency and clinical presentation. J Pediatr Endocrinol Metab 2007; 20: 1137-40.
National Institute for Health and Care Excellence (NICE) NG18. Diabetes (Type 1 and Type 2) in children and young people: diagnosis and management, August 2015. Available from:. https://www.nice.org.uk/guidance/ng18
Bismuth E, Laffel L. Can we prevent diabetic ketoacidosis in children? Pediatr Diabetes 2007; 8(Suppl. 6): 24-33.
Prasanna KKM, Krishna P, Reddy SC, Gurrappa M, Aravind SR, Munichoodappa C. Incidence of type 1 diabetes mellitus and associated complications among children and young adults: Results from Karnataka Diabetes Registry 1995-2008. J Indian Med Assoc 2008; 106: 708-11.
Kota SK, Meher LK, Jammula S, Kota SK, Modi KD. Clinical profile of coexisting conditions in type 1 diabetes mellitus patients. Diabetes Metab Syndr 2012; 6: 70-6.
Kalra S, Kalra B, Chatley G. Prevalence of hypothyroidism in pediatric type 1 diabetes mellitus in Haryana, Northern India. Thyroid Res Pract 2012; 9: 12-3.
American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care 2013; 36(Suppl. 1): S11-66.
Umpierrez GE, Latif KA, Murphy MB, et al. Thyroid dysfunction in patients with type 1 diabetes: A longitudinal study. Diabetes Care 2003; 26: 1181-5.
Joseph J, Saroha V, Payne H, et al. Thyroid function at diagnosis of type I diabetes. Arch Dis Child 2011; 96: 777-9.
Kordonouri O, Hartmann R, Deiss D, Wilms M, Grüters-Kieslich A. Natural course of autoimmune thyroiditis in type 1 diabetes: Association with gender, age, diabetes duration, and puberty. Arch Dis Child 2005; 90: 411-4.
Dosi RV, Tandon N. A study on prevalence of thyroid auto-immunity in type 1 diabetes mellitus. J Indian Med Assoc 2010; 108: 349-350, 355-356.
Virmani A. Growth disorders in type 1 diabetes: An Indian experience. Indian J Endocrinol Metab 2015; 19: 64-7.
Kappelman MD, Galanko JA, Porter CQ, Sandler RS. Association of paediatric inflammatory bowel disease with other immune-mediated diseases. Arch Dis Child 2011; 96: 1042-6.
Cooper JG, Claudi T, Thordarson HB, et al. Treatment of type 1 diabetes in the specialist health service--data from the Norwegian Diabetes Register for Adults. Tidsskr Nor Laegeforen 2013; 133: 2257-62.
Fritsch M, Rosenbauer J, Schober E, Neu A, Placzek K, Holl RW. Predictors of diabetic ketoacidosis in children and adolescents with type 1 diabetes. Experience from a large multicentre database. Pediatr Diabetes 2011; 12: 307-12.
Kanwal SK, Bando A, Kumar V. Clinical profile of diabetic ketoacidosis in Indian children. Indian J Pediatr 2012; 79: 901-4.
Type 1 Diabetes A very special issue. Diabetes Voice. Global perspectives on Diabetes. Brussels: International Diabetes Federation; 2011; Vol 56: Special Issue 2. Available from http://www.idf.org/diabetesvoice
Campbell MS, Schatz DA, Chen V, et al. A contrast between children and adolescents with excellent and poor control: the T1D Exchange clinic registry experience. Pediatr Diabetes 2014; 15: 110-7.
National Institute for Health and Care Excellence. Type I diabetes in adults: diagnosis and management. UK; 2015 [2016 July]. Available from:. https://www.nice.org.uk/guidance/ng17
Abdelghaffar S, Attia AM. Metformin added to insulin therapy for type 1 diabetes mellitus in adolescents. Cochrane Database Syst Rev 2009; 1: CD006691.
Vella S, Buetow L, Royle P, Livingstone S, Colhoun HM, Petrie JR. The use of metformin in type 1 diabetes: A systematic review of efficacy. Diabetologia 2010; 53: 809-20.
Sheriba NA, Ahmed IZ, Abdesalam MM, Eid YM, Mahdy MM, Mansour HK. Effect of Metformin therapy on serum Fetuin levels in insulin resistant Type 1 diabetics. Curr Diabetes Rev 2018; 14(3): 291-7.
Bhatia V, Arya A, Dabadghao P, et al. Etiology and outcome of childhood and adolescent diabetes mellitus in north India. J Pediatr Endocrinol Metab 2004; 17: 993-7.
Secrest AM, Becker DJ, Kelsey SF, LaPorte RE, Orchard TJ. Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes. Diabetes 2010; 59: 3216-22.

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Published on: 18 January, 2019
Page: [141 - 148]
Pages: 8
DOI: 10.2174/1573399814666180424123255
Price: $65

Article Metrics

PDF: 28