Burden of diabetes increasing among young population in India, says ICMR; lists key triggers and managements

At a time when the scare of COVID pandemic is still looming, the Indian Council of Medical Research (ICMR) has released guidelines for type 1 diabetes management. The pandemic has disproportionately affected people with diabetes, exposing them to a high risk for severe illness and mortality, the ICMR has said.

There are several reasons why diabetes should be managed at the right time. In 2019, it had claimed over 4 million deaths and was the leading cause of kidney disease, cardiovascular disease and blindness.

The incidence of type 1 diabetes in the young population is a matter of concern. As per the International Diabetes Federation (IDF) Atlas, 9th edition nearly 1.1 million people below 20 years of age are estimated to be affected by type 1 diabetes.

Type 2 diabetes is the commonly occuring form of diabetes. More than 95% of people with diabetes have type 2 diabetes which mostly results from excess body weight and physical inactivity.

Type 1 diabetes is characterized by lack of insulin production which requires regular administration of it. Insulin is a hormone that our body needs so that the glucose is absorbed by the cells and energy is produced for the normal functioning of the body.

There are several factors that lead to type 1 diabetes in individuals like genetics.

"In 2017 there were 9 million people with type 1 diabetes; the majority of them live in high-income countries. Neither its cause nor the means to prevent it are known," the WHO says.

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The common symptoms associated with type 1 diabetes are:

Polyuria or excessive excretion of urine

Polydipsia or excessive thirst

Constant hunger

Weight loss

Changes in vision

Extreme fatigue

Those with type 1 diabetes are prone to several infections.

Infections like rhino-orbital-cerebral mucormycosis- head and neck infection caused by fungi, malignant otitis externa- an infection in the external auditory canal which spreads to deep tissue, necrotizing fasciitis, fournier gangrene, emphysematous cholecystitis- a gastrointestinal infection, emphysematous pyelonephritis, and diabetic foot infections are more specific to patients with type 1 diabetes.

These people are also prone to pneumonia, soft tissue infections and urinary tract infection.

"Over one million children and adolescents in the world have type 1 diabetes, and recent estimates from the International Diabetes Federation suggest that India has the highest number of incidents and prevalent cases of type 1 diabetes in the world," the ICMR says.

The incidence of type 1 diabetes in India is 4.9 cases per 100000 per year. The peak incidence of this disease is seen between 10-14 years of age.

ICMR says genetic factors are a major reason behind the occurence of type 1 diabetes. The risk of getting this disease is 3%, 5%, and 8%, respectively, when

mother, father, and siblings have it.

ICMR recommends dividing the entire calorie consumption per day into 6-7 meals which includes 3 major meals and 3-4 snacks. "In general, represent

breakfast with 20% of total caloric needs, lunch, and dinner with 25- 30%, and each snack with 10% of daily calorie inputs," it says.

The ICMR makes nutritional recommendations for those having type 1 diabetes. As per the ICMR guidelines the recommended carbohydrate intake is 50-55% of total calories; too much of it can hamper growth.

It has also said that in the parts of the country, mostly South-India and East-India, where simple carbohydrate is an essential part of the diet, the intake of complex carbohydrates should be encouraged to constitute at least 70% of the total carbohydrates.

The medical research organisation advises people to have healthy sources of carbohydrate foods like wholegrain bread and cereals/ millets, legumes (peas, beans, and lentils), fruits, vegetables, and low-fat dairy products.

It also recommends having 14 g of fiber per 1000 kcal. "Recommended daily intake for fats is up to 30% of total calories. Infants and children younger than two years of age may have a higher daily fat intake of up to 35%," it says about including fat in the diet.

While the recommended protein intake is 15-20% of the calorie requirement, it can be calculated as 2 g/kg at one year, 1 g/kg at ten years to 0.8-0.9 g/kg in adolescence.

The ICMR recommends including physical activity in daily routine. Regular physical activity prevents obesity and cuts down the risk of cardiovascular risk. It also improves glycaemic control and reduces microvascular complications.