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The challenge of childhood diabetes mellitus in India

I C Verma

    Indian Journal of Pediatrics
    |November 1, 1989
    PubMed

    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.

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