T1D Around the World: India
Jaylyn Porras and Mariana Turner
- T1D is a big problem in India, but most specifically in children.
- Misclassification of T1D and T2D is a problem in young adults in the population due to the high prevalence of early onset T2D at lower BMI.
- T1D genetic risk score (GRS)derived from Europeans can still be discriminative of T1D from T2D in Indians.
- The absence of a nationwide registry has led to uncertainty regarding the numbers of people with T1D in India.
- The large numbers ofT1 diabetics in India, the increasing recognition of childhood and early adulthood onset of T2D and recent studies highlighting the frequency of adult onset T1D all emphasize that tools such as the T1D GRS are needed to discriminate between people with T1D and T2 diabetics in non-European populations.
The Children in India
In 2015, over 25% of the children diagnosed with T1D globally were located in India. Sadly, most of these children were dying not long after diagnosis. Luckily, the survival rate has been increasing due to India’s reduction in poverty, improved health care personnel awareness, , an increase in trained specialists and the advancement in communication and technology.. With these improvements, Indian children are being diagnosed sooner.
According to an article written by Anju Virmani, in 2006 the Indian Council of Medical Research set up a Registry of People with Youth Onset Diabetes ( under age 25) that initially aimed to enroll all youth onset cases residing within the geographical areas of eight collaborating centers across India. The council was quick to realize that this would not lead to a nationwide registry or even complete ascertainment, and thus the primary objective became, “to understand disease patterns or types of youth onset diabetes, including their geographical variations within the country and to estimate the burden of diabetes complications.”
What they found:
- Glycemic control leaves much scope for improvement even in tertiary-care centers with multidisciplinary teams.
- Severe hypoglycemia occurs frequently, especially in young children.
- Hypertension occurs often and early – this matters, as it contributes to nephropathy, renal failure and mortality.
- Death occurs often and early, with diabetes a major contributor.
The good news. MDI is possible whatever the age, education, socio-economic status, or residence (urban or rural). Hypertension is easy to detect and treatable. Hypoglycemia rates can be brought down with technology. Lastly, the increase in the incidence, along with enhanced access to insulin and better survival rates, will lead to a higher prevalence in the near future.
- Harrison, J. W., Tallapragada, D. S., Baptist, A., Sharp, S. A., Bhaskar, S., Jog, K. S., . . . Oram, R. A. (2020, June 11). Type 1 diabetes genetic risk score is discriminative of diabetes in non-Europeans: Evidence from a study in India. Retrieved from https://www.nature.com/articles/s41598-020-65317-1
- Jevalikar G, Kohli C, Bansal B, Mishra SK, Wasir JS, Singh S, et al. Childhood and youth onset diabetes: a single center experience. Indian J Pediatr. 2016; 83:792-8.
- Kumar, K. M. (2015, April). Incidence trends for childhood type 1 diabetes in India. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4413385/
- Virmani, A. (n.d.). Type 1 Diabetes in India: The Numbers Show the Way Ahead. Retrieved August 4, 2020, from https://www.indianpediatrics.net/mar2019/mar-189-190.htm