Trends of type 1 diabetes in Karachi, Pakistan

Our study aims to assess the presentation, prevalence, and associations of acute and chronic complications in subjects with type 1 diabetes mellitus (T1DM) at their first visit to outpatient departments.

Study was carried out at two centers, Diabetic Association of Pakistan and WHO Collaborating Centre and Baqai Institute of Diabetology and Endocrinology, Karachi. Records of 591 T1DM subjects divided into two groups were studied. Group 1 (62.1%, n = 367) includes patients with known T1DM and group 2 (n = 224, 37.9%), newly diagnosed T1DM. Clinical features [polyuria, polydipsia, polyphagia, history of weight loss, and history of diabetic ketoacidosis (DKA)] were recorded. Biochemical parameters including fasting plasma glucose, 2-h postprandial plasma glucose, hemoglobin A1c, urinary ketones, and proteinuria were recorded. Arterial blood gases was done in suspected cases of DKA.

In group 1, male predominance was seen (57.8 vs. 42.2%). Mean age at presentation was 19.1 +/- 10 yr. Mean duration of diabetes was 16 +/- 9 yr. Two percent subjects presented with DKA, while 21% had a history of DKA. Among the subjects with >10 yr of diabetes, 20.1% had hypertension, 5.5% had nephropathy, 2.9% had neuropathy, and 7.7% had retinopathy. In group 2, 224 T1DM subjects were identified, with mean age of 17 +/- 11 yr. Equal number of males (50.9%) and females (49.1%) were diagnosed at their first presentation. Most subjects (40.8%, n = 91) diagnosed between 11 and 20 yr of age presented with polyuria (81.3%), polydipsia (77.2%), polyphagia (56.7%), and weight loss (79.5%). Ketonuria was positive in 4.9%, while 5.8% presented with DKA.

This is the first study in Pakistan to assess the mode of presentation and prevalence of acute and chronic complications in T1DM. Larger scale prospective studies are needed to have more detailed informative data.