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With India being home to the world’s second largest adult diabetes population, the Indian Council of Medical Research (ICMR) has come out with guidelines for management of type I diabetes.
The ICMR type 1 diabetes guidelines come at a time when the SARS-CoV-2 pandemic has disproportionately affected people with diabetes, exposing them to a high risk for severe illness and mortality. India is home to the world's second largest adult diabetes population and every sixth person with diabetes in the world is an Indian.
Type 1 diabetes mellitus (T1DM) is an autoimmune disease characterized by insulin deficiency and hyperglycemia in people with underlying genetic susceptibility. The incidence of T1DM in India is 4.9 cases/100000/year. The peak incidence for T1DM is seen between 10-14 years of age, though it can affect an individual at any age. Genetic factors play a significant role in the etiology of T1DM. The risk of T1DM is 3%, 5%, and 8%, respectively, when mother, father, and sibling have T1DM.
The past three decades witnessed 150 per cent increase in the number of people with diabetes in the country. The growing prevalence of pre diabetes indicates a further increase in diabetes in the near future.
“In India, there exists a considerable variability in the quality of diabetes care, which depends upon various factors such as accessibility to services, affordability of drugs, attitude and perceptions of care providers, lack of specialists and diabetes educators, standardized laboratories and treatment guidelines. Although several international guidelines are available for type 1 diabetes management, a context specific culturally adaptive guideline that ensures affordable diabetes care is the need of the hour to inform the diabetes care providers in low- and middle-income countries such as India. The ICMR type 1 diabetes guidelines is a comprehensive document providing advice on care of diabetes in children, adolescents and adults with type 1 diabetes. All chapters in this guideline have been provided with formation to reflect advances in scientific knowledge and clinical care that have occurred in the recent past. ICMR is committed to update this document periodically to inform clinicians and diabetes care providers on future advances in type 1 diabetes care,” said Prof. (Dr.) Balram Bhargava, Secretary, DHR and director general, ICMR.
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The guidelines include epidemiology and diagnosis and guide for differential diagnosis, lifestyle -diet and exercise, drugs -insulin and other, monitoring of metabolic control, acute complications -diabetic ketoacidosis, hypoglycemia and infections, microvascular complications – retinopathy, nephropathy, – neuropathy etc.
Lifestyle management (LSM) plays an essential role in managing type 1 diabetes mellitus (T1DM). Understanding the effect of diet and physical activity on glycemia is essential for optimal management of T1DM. People need to maintain optimal blood pressure, weight, and lipid levels, ensure adequate nutrition to facilitate healthy growth and development in children, and address individual nutrition needs, incorporating personal, social, and cultural preferences, stated the ICMR guidelines.
"Indian (especially South-Indian and East-Indian) diets are rich in simple carbohydrates. The intake of complex carbohydrates should be encouraged to constitute at least 70 per cent of the total carbohydrates," the guidelines read. Meanwhile, regular physical activity increases the feeling of general well-being and helps prevent obesity, and mitigates increased cardiovascular risk.
All children and adults with type 1 diabetes (T1DM) require insulin as soon as they are diagnosed and continuously thereafter throughout life. Therefore, it becomes important to be careful while using them. ICMR in its guidelines states that whatever the insulin regimen, its optimal use depends on the painstaking care taken by a diabetes team, including the physician, diabetes educator, and nutritionist, to educate and support the patient and his/her family regarding their best use as well as insulin dose adjustment.
ICMR has also identified some side effects that could happen due to insulin, which include Hypoglycemia, weight gain, and infection. "An optimal insulin dose is one which will achieve good glycemic control without frequent hypoglycemic episodes," ICMR states.
According to ICMR guidelines, blood glucose monitoring is a key factor that predicts glycemic control in patients with type 1 diabetes. The American Diabetes Association (ADA) recommends that patients with type-1 diabetes should monitor blood glucose prior to meals and snacks, at bedtime, prior to exercise, when they suspect low plasma glucose, and after treating low plasma glucose (till blood glucose is normal), and before starting any critical tasks such as driving.
Individuals with type 1 diabetes need support to survive, use insulin and other therapies, and to live their entire life without stigma, restrictions, or disabling complications due to their illness, the health body said.
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