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The challenge of childhood diabetes mellitus in India
Insights
Childhood diabetes mellitus (DM) affects 0.4/1000 children, with specific genetic markers like HLA Bw21 and DR3 linked to Type 1 DM. Malnutrition-related DM in India presents differently, lacking these genetic associations.
Area of Science:
- Pediatrics
- Endocrinology
- Immunology
Background:
- Diabetes Mellitus (DM) in children has a prevalence of approximately 0.4/1000, with children representing 3-5% of all diabetes cases.
- A significant portion of pediatric DM cases do not present with ketoacidosis upon admission, and some have an early onset before age 4.
Purpose of the Study:
- To investigate the immunological and genetic factors associated with childhood Type 1 Diabetes Mellitus (T1DM).
- To describe the characteristics and potential etiologies of Malnutrition-Related Diabetes Mellitus (MRDM) in Indian adolescents.
- To assess the mortality rates and contributing factors in pediatric DM patients.
Main Methods:
- Analysis of HLA antigen and islet cell antibody (ICA) prevalence in childhood T1DM.
- Serological testing for Coxsackie B2 virus antibodies.
- Measurement of C-peptide levels.
- Clinical and biochemical characterization of Malnutrition-Related Diabetes Mellitus (MRDM).
Main Results:
- Childhood T1DM showed strong linkage disequilibrium with HLA antigens Bw21 (RR=12.7) and DR3 (RR=16.6).
- Islet cell antibodies (ICA) were found in 30.9% of T1DM patients, and increased antibodies against Coxsackie B2 virus were observed (75.5%).
- MRDM in Indian adolescents presented with moderate hyperglycemia, low serum glycerol, insulin insensitivity, and pancreatic abnormalities, without association with HLA or ICA; mortality was higher in resource-limited settings.
Conclusions:
- Childhood T1DM has distinct genetic and immunological markers, including specific HLA types and autoantibodies.
- Malnutrition-Related Diabetes Mellitus (MRDM) is a distinct entity in adolescents, with unclear etiology but significant clinical implications.
- Effective management and healthcare access are crucial for reducing mortality in pediatric DM, especially in impoverished regions.
Abstract:
The prevalence of DM is about 0.4/1000 children with a lower incidence in the rural areas. Children comprise 3-5% of the total diabetics. A study of 55 pediatric cases of DM (1980-84) showed that only 22 (40%) had ketoacidosis on admission. Ten (18.2%) had onset of illness before 4 years of age. HLA antigen studies in childhood IDDM have shown a positive linkage disequilibrium with Bw21 (RR-12.7), and DR3 (RR = 16.6). Prevalence of islet cell antibodies (ICA) was 30.9% (n = 110) as compared with 0.8% in controls. Antibodies against Coxsackie B2 virus were increased (75.5% vs 46.4% in controls). The C-peptide content was substantially low. Malnutrition related DM occurs in adolescents in some parts of India. It is characterized by moderate hyperglycemia, low serum glycerol, relative insulin insensitivity, and pancreatic malformation/calcification in about 1/4 of subjects. There is no association with HLA antigens or ICA, and the precise etiology is unclear. Mortality was 3.6% in patients admitted in our hospital but is higher in other regions due to poverty and relative lack of health care facilities.