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DIABETES MELLITUS IN CHILDREN OF INDIA AND KYRGYZSTAN.
Authors & Affiliation
1.Bugubaeva makhabat mitalipovna.
2.Veerappan Sanjay.
(1. Teacher , International Medical Faculty, Osh State University, Osh, Kyrgyzstan.)
(2 .Student, International Medical Faculty, Osh State University, Osh, Kyrgyzstan.)
ABSTRACT
DM involves absence of insulin secretion (type 1) it’s a autoimmune condition that leads to destruction of pancreatic cells leading to insufficient insulin production. Here in this article we are going to summarise all the reasons and government measures taken to tackle the growing T1DM cases in the pediatric patients. Both governments have taken best measures and have few setbacks in their progress.
INTRODUCTION
Diabetes mellitus is a chronic medical condition that causes problems with the bodies ability to change food especially sugars (carbohydrates) into fuel for the body. It represents one of the most common endocrine and metabolic conditions in childhood, with a significant impact on physical growth, psychological well-being, and long term health outcomes.
DM involves absence of insulin secretion ( type 1) it’s a autoimmune condition that leads to destruction of pancreatic beta cells leading to insufficient insulin production or Peripheral insulin resistance ( type 2) causing hyperglycemia .
The types of DM in children are similar to those in adults,but psychosocial problems are line spacing 1.5different and can complicate treatment .
DM (TYPE 1) IN CHILDREN IN INDIA
India has the highest number of T1DM cases in children globally, with an estimated 1,03,200 cases in 2024 though in year 2019 it was about 97,700 cases only recorded . T1DM shows an increasing incidence of about 3-5% per year .Prevalence rates vary by region, with some studies showing higher rates in urban areas compared to rural areas . India has 3 new cases of T1DM / 1,00,000 children of 0-14 years .
Three sets of prevalence data shows 17.93 cases/ 1,00,000 children in Karnataka, 3.2 cases/1,00,000 children in Chennai, and 10.2 cases/1,00,000 in Karnal (Haryana) .
According to statistical data , in India its observed that 6.4% children were undernourished (3.4% severe undernutrition) and 17.7%(overweight 13.2%) had combined obesity . 21.2 % of them had short stature ( adjusted for mid parental height )
Possible reasons of T1DM in children in India
Environmental factors :
In India exposure to antigenic substances early in life is thought to contribute to T1DM undissolved gluten causes subclinical inflammation of intestinal mucosa, which rises the proportion of aggressive T cells . the functional state of beta cells places a role in the pathogenesis of T1DM and food intake with high glycemic index increases the insulin demand and forces the beta cell to produce more insulin , which accelerates its destruction .
Nutrition and dietary factors :
Breast feeding appears to provide protection against the risk of developing T1DM . In india data shows that lack of breast feeding is a possible modifiable risk factor for the manifestation of both T1DM and T2DM . Breast feeding may be viewed as a surrogate for the delay in the introduction of diabetogenic substances precent in formula or early childhood diet .
Pancreatic beta cell reserve – C – peptide assay :
C peptide determination is used to better understand the course of T1DM . In India , it was shown that young children with classical ketosis prone insulin dependent diabetes also had residuel insulin secretion . Very young children especially those with onset after infections end to have less C peptide .
Though the exact cause is unknown but it occurs when harmful bacteria and viruses mistakenly destroy islet cells in pancreas . once these cells get destroyed there will be no insulin which can lead to life threatening complications like heart and blood vessels damage ( narrowing of blood vessels , stroke ) , nerve damage ( numbness) , kidney damage , eye damage ( retinal blood vessel damage ) , osteoporosis .
Government steps to curb T1DM in India :
(1) For maintaining diabetes record , there is registry maintained by the Indian council of medical research called as YDR ( Young Diabetes Registry ) since year 2006
(2) The YDR recruits patient with young onset diabetes ,diagnosed on or before 25 years of age . the registry operates at 205 centers from 10 cities across India .
(3) According to the YDR registry data out of 20,351 young diabetes patients recruited ,13,368 (65.6%) were T1DM .
(4) According to the 10th International Diabetes Federation Atlas 2021,the number of children with T1DM in India is 22,94,000 in the age group of 0-19 years .
According to this study the average annual incidence of T1DM (below 20 years) is 4.9 cases per 1,00,000 population .
The Department of Health and Family Welfare provides technical and financial support to the states under the National Programme for Prevention and Control of Cancer , Diabetes , Cardiovascular Diseases and Stroke ( NPCDCS) , as a part of National Health Mission (NHM) , based on the proposal received from the state . Under this programme all the age groups , including children are covered .
Under Free Drugs Service Initiative of NHM , financial support is provided to the states for the provision of free essential medicines including insulin for the poor and needy people including children .
Further more , quality generic medicines including insulin are available at affordable prices to all , under “ Jan Aushadhi Scheme ” , in collaboration with the state governments .
DM (TYPE 1) IN CHILDREN IN KYRGYZSTAN
In Kyrgyzstan , type 1 diabetes in children has as increasing incidence rate , but several factors create challenges in management and care , including potential underdiagnosis , high hospitalization rates , and limited access to specialized care and medication in rural areas .
As of 01 January 2017 , 368 children were registered with T1DM in Kyrgyzstan . On the same date , a total of 2071 people ( including children < 14) were registered with T1DM , children under 14 numbered 319 .
According to the International Diabetes Federation (IDF) Atlas : prevalence for children aged 0-14 yrs in Kyrgyzstan is approximately 1.2 cases per 100,000 population and estimated prevalent cases – 0.1 thousand . The same Atlas gives for 0-19 yrs – 947 people living with T1DM in that age group.
Among patients with T1DM in Kyrgyzstan , 52% were male 47.6% are female. Children with T1DM in Kyrgyzstan face substantial barriers , stigma in school , access difficulties to kindergartens , school , interruptions in insulin , glucose monitoring supplies .
Government measures taken :
1) The health system shows regional variation in T1DM care organization , rural / remote areas have less involvement of family doctors .
2) Data collection on T1DM in children is incomplete , many cases likely under registered due to limited diagnostics and registries .
3) Government has provided Insulin & free access to essential diabetes supplies . Free blood glucose meters for children and adolescents , and partial reimbursement of test strips under one mechanism .
4) Inclusion of T1DM in national health policy framework , T1DM is listed among priority non communicable disease in Kyrgyzstan . Government programmes ( MANAS TAALIMI , “ DEN SOOLUK “ ) have included diabetes care and prevention .
5) Pilot projects to train teachers , school nurses , social workers in supporting children / youth with T1DM , improving the school environment for diabetic children .Measures to ensure that children under 29 get coverage for insulin and support .
Centralized procurement of insulin and supplies through the ministry of health (MoH) to ensure cost efficient and supply predictability .
CONCLUSION
As per the research done and references done in various official and government websites the prevalence of the T1DM in both countries ( INDIA and KYRGYZSTAN ) in growing day by day . The government has take many measures to face the upcoming challenges to the young children. But there are various challenges to face like the limitation of supplies and proper healthcare in rural remote areas . Yet there are important implementation and equity gaps like technologies , rural access, full school coverage , primary care involvement and early diagnosis .India shows a higher reported prevalence of T1DM in children , estimated 97,000 cases with the incidence rates ranging from 3.7 to 26.6 per 100,000 children. In Kyrgyzstan, data are although less extensively documented , exhibits similar trends of increasing incidence among children , compound by factors like genetics , environmental influences and immunological mechanism . Both countries require targeted strategies for early diagnosis, improved healthcare access , and public education to combat the rising burden of T1DM in pediatric populations.
REFERENCES
1.https://www.apollohospitals.com/diseases-and-conditions/type-1-diabetes-in-children
2.www.thelancet.com
3. redcliffelabs.com
4.www.mayoclinic.org
5.Das, A. K., et al. (2015). Type 1 diabetes in India: overall insights. Indian Journal of Endocrinology & Metabolism / PMC. — Useful: classic review summarizing incidence/prevalence estimates across Indian states and earlier registry/clinic studies (gives baseline incidence ~3/100,000 in some datasets).
6. Verma, H., et al. (2023). Prevalence and associated clinical features of Type 1 diabetes in Indian youth. Diabetes Research and Clinical Practice (open access). — Useful: more recent hospital/registry-based prevalence and clinical-profile data for children/adolescents.
7. Oza, C., et al. (2024). Prevalence and predictors of diabetic retinopathy and other complications in young people with T1D in India. Clinical Ophthalmology / Journal. — Useful: complications data (retinopathy prevalence in pediatric/young-adult T1D cohorts).
