Managing diabetes in children is not a cakewalk and is, infact, the more challenging as this is the stage where the kids are growing and developing. Any compromises in nutrition could lead to malnutrition, deficiencies, or delayed growth and development.
While the most common type of diabetes in kids is type 1 diabetes, the cases of type 2 diabetes in children and adolescents too are on the rise. In type 1 diabetes, the pancreas fails to make insulin-a hormone that helps glucose get into human cells to give energy. Without insulin, too much glucose remains in the blood.
"Various hospital and clinic-based registries in India stated that the percentage of type 2 diabetes in kids is growing. Type 2 diabetes used to be known as adult-onset diabetes. But now it has become more common in children and teens, due to more obesity. Type 2 Diabetes is due to decreased action of insulin or insulin resistance," says Dr. Phulrenu Chauhan, Consultant Endocrinologist at P.D.Hinduja Hospital & MRC, as quoted by Hindustan Times.
The rise in sedentary lifestyles and faulty eating habits in children is a cause of concern as this could increase their chances of type 2 diabetes.
"Children have a high risk of type 2 diabetes if they are overweight or are obese, have a family history of the disease, or lack physical activities," says Dr Chauhan.
At the Diabetes Unit of KEM Hospital, Pune, scientists have been researching for 35 years as why diabetes is so common among Indian people. In 1993, they embarked on the Pune Maternal Nutrition Study (PMNS) across six villages nearby Pune, and followed over 700 families. They had tracked women before they became pregnant and during their pregnancy, and later their children through childhood, puberty and now as adults.
Findings Of Research
Researchers measured glucose and insulin concentrations and other important data of children aged 6, 12, and 18 years respectively. At 18 years, 37 per cent of men and 18 per cent of women had elevated glucose levels (prediabetes), despite half these participants being underweight, The Indian Express reported.
Children with sub-optimal growth in the womb carry high-risk factors for diabetes from early childhood like high circulating glucose levels.
The tendency towards high glucose was evident even when measured at ages 6 and 12. The researchers said that this was driven by a poorly functioning pancreas, which could not cope with the demands of rising age, which likely reflects poor growth of the pancreas during foetal life as part of general growth failure. When maternal glucose is minimally increased during pregnancy, it stresses the baby's pancreas.
Diet For Diabetic Children
"Diet therapy, exercise and pharmacotherapy form an integral part of diabetes management. Nutrition requirements in kids are different from those in adults as they are in the growing stage. During the same period, children with diabetes are not different from normal children regarding nutritional requirements. It becomes even more critical to meet nutritional needs without compromising with the blood sugar levels," says Sweedal Trinidade, HOD Dietary Services at P.D. Hinduja Hospital & MRC, Mahim, Mumbai.
Modern therapies like insulin pumps, rigid diet regimes, flexible injection regimes, are no longer part of dietary management in kids with type 1 diabetes enabling them to lead a more typical lifestyle.
"Customised meal plans considering food preferences, culture, physical activity, schedule are essential to strike a perfect balance between ideal therapeutic diet and occasional allowances to maintain optimum blood sugar levels," Trinidade said.
According to the World Health Organization (WHO), India has nearly 8.7 per cent diabetic population in the age group of 20-70, with nearly 77 million individuals with diabetes.
A first national nutrition survey in 2016-18 by the Union Ministry of Health and Family Welfare, UNICEF and Population Council among children and adolescents also found that diabetes affects children significantly. Released in 2019, the survey said that about 1 in 10 children aged between 5-9 years were pre-diabetic, and 1% was already diabetic.
The increasing prevalence of diabetes is driven by a combination of factors like rapid urbanisation, unhealthy diet, sedentary lifestyle, tobacco use, and increasing life expectancy.
The present recommendation from the government to begin screening for diabetes is at age 30.
Diabetes prevention trials still mainly target middle-aged persons who already have obesity and advanced metabolic abnormalities, Dr Yajnik stated.
"An integrated life course approach is needed and prevention has to start at the community level and not just in the clinic. Apart from doctors, we need public health experts to work on this," Dr Yajnik said. "Constructing such evidence is beyond the scope of clinicians and will take longer. We need to act sooner than later," he said.
"This is predominantly in the research domain. We do not have enough data to translate in the public health domain, especially in a resource-limited country like India. We need tough translational research that is reproducible, affordable and has hard evidence from a public health standpoint," Dr Shashank Joshi, Chairman, International Diabetes Federation, South East Asia, said.
A new report published in the journal Diabetes and Metabolic Syndrome–Clinical Research and Reviews, too, shows a trend of the surging prevalence of diabetes in youth in the last 10 years. After analysing data from different diabetes centres, researchers found that 77.6% of those below 30 were either overweight or obese.
Dr Anoop Misra, the report's lead author, had said the government should lower the age of screening.
"This is a country-wide study and others have recommended screening above 25 years in resource-limited nations, including India. The focus is also on women and child health. Maternal nutrition during pregnancy should be focussed upon as a preventive measure," Dr Joshi said.
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