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50. DIABETES MELLITUS IN CHILDREN OF INDIA AND BANGLADESH
Authors & Affiliation
1.Bugubaeva Makhabat Mitalipovna.
2.Palanisamy Ruban.
(1.Associate Professor , HOD Clinical Disciplines , Osh State Medical University , International Medical Faculty .)
(2 .Student, International Medical Faculty, Osh State University, Osh, Kyrgyzstan.)
ABSTRACT
Diabetes Mellitus in Children 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 DM 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.
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 in children are similar to those in adults,but psychosocial problems are line spacing 1.5different and can complicate treatment .
DM in children of developing countries like India and Bangladesh is growing in a significant rate . DM is though a non communicable disease but it has its own risk in causing multiple systemic diseases as well especially in children . since these countries have developing the people’s food habits and the environment causes affect the future children of these countries . This article will overview the causes of DM in children of these countries and the measures taken by the government to face the growing DM cases in children in their country .
DM IN CHILDREN IN BANGLADESH
Diabetes in children is an increasing concern in Bangladesh , with rising rates of DM .
So far Bangladesh has the highest population density (1007/sq km) in the world with a total population of 165 million . Of this total 61 million people are in the age <18 years .
According to the health survey for England 2004 , doctor diagnosed diabetes is almost 4 times prevalent in Bangladesh male children and almost 3 times prevalent in Pakistan and Indian children .
The above mentioned stats shows that Bangladeshi children are more prone to DM then Indian children due to faster growing urbanizing environment affecting the lifestyle of the native population .
The study protocol was duly submitted to “ Ethical Review Committee ” of the Diabetes Association of Bangladesh (DAB) and the committee approved the protocol .
According to the result of the practice a total of 2152 children. The participants from rural area were 800 , urban 949 and suburban were 402 .
Of these 53% were from the middle class and 25.5% from the poor and 21% rich social class. The prevalence of DM (95%) was 1.8% .Compared with girls the boys had significant high prevalence of DM . The prevalence of DM increased with age and social class status . The prevalence of DM were significantly higher in the urban children as compared to suburban and rural counter parts . Taking the result as dependent variable and age , sex, are , social class and BMI as covariates we found that only higher age and urban area were proved to have independent risk . This analysis indicates that irrespective of sex , social class , and obesity these children had equal risk for developing diabetes .
Government measures taken :
1 ) The Japan International Cooperation Agency (JICA) and the Diabetes Association of Bangladesh (BADAS) have provided technical support to the Non Communicable Disease Control (NCDC) to develop a National Guideline on Diabetes Mellitus , as press release . The guideline was launched on August 6 , 2023 and it will help guide Bangladeshi physician to choose adequate treatment for managing their patients .
2 ) Bangladesh has started a target of placing 3 million people with diabetes on protocol based care 2025,via involvement of community clinics , union facilities , sub district hospitals , with diagnostics and essential drugs .Tis expansion of primary care access is foundation for children . It helps to manage the diabetes in young children early .
3 ) In 2024 – 2025 a program run by ICDDR , in collaboration with DGHS and supported by UNICEF Bangladesh developed the first national treatment protocol for paediatric patient .
While many policies cover Diabetes broadly specific targeted programmes for children with type 1 diabetes remains less prominent and appear a pilot or early stage . Ensuring equity of access is challenge : e.g , transport costs , follow up difficulties have been identified .
Monitoring & data : reliable national data on incidence of type 1 in children and outcomes remains limited , which constrains policy design and evaluation
DM IN CHILDREN IN INDIA
India has the highest number of DM 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 . DM 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 DM / 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 DM in children in India
Environmental factors :
In India exposure to antigenic substances early in life is thought to contribute to DM 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 DM 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 DM . In india data shows that lack of breast feeding is a possible modifiable risk factor for the manifestation of both DM and T2 . 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 DM . 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 DM 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 DM .
(4) According to the 10th International Diabetes Federation Atlas 2021,the number of children with DM in India is 22,94,000 in the age group of 0-19 years .
According to this study the average annual incidence of DM (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 .
CONCLUSION
As per the research done and references done in various official and government websites the prevalence of the DM in both countries ( INDIA and BANGLADESH ) 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 DM in children , estimated 97,000 cases with the incidence rates ranging from 3.7 to 26.6 per 100,000 children. In Bangladesh, 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 DM in pediatric populations.
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• Singh, A.C. (2000) Bangladesh Bureau of Statistics. Statistical pocket book of Bangladesh 2000. In: Singha, A.C., Ed., Statistical Division, Ministry of Planning, Government of the People’s Republic of Bangladesh, Dhaka.
• [International Diabetes Federation (2009) Diabetes atlas. 4th Edition.
