Abstract Details

Session title: Complications - kidney

Session type: Poster - Epidemiology and Public Health

Track: Epidemiology and Public Health

Presentation number: P-0946

Abstract title:

Diabetic kidney disease [DKD] in poverty associated childhood diabetes in India: prevalence correlates and challenges

Presenting Author: Priya M

Background

Type 1 diabetes accounts for a majority of childhood and adolescent diabetes, especially in economically impoverished societies. With the rising prevalence of diabetes in children, a rise in diabetes-related complications, such as nephropathy, is anticipated. In an affluent cohort from USA, events in the natural history of diabetic nephropathy (including the onset of persistent proteinuria and end-stage renal failure) have been studied in childhood onset type I diabetes who were followed for 20 to 40 years. The risk of persistent proteinuria increased rapidly between the 5th and 15th years of diabetes and declined thereafter. This pattern suggests that susceptibility to this complication was limited to a subset of patients and was exhausted over time. Analogous and additional information in poverty / resource limited situations would be most useful in designing and implementing prevention strategies.

Aim

To analyse the prevalence, correlates and challenges [2011-2016] of diabetic kidney disease in a cohort of economically underprivileged children with type 1 diabetes [onset 1-18 y] DISHA Free Clinic, India.

Method

DISHA: Beginning 1987, 2000 children provided free insulin, syringes, health counselling, 24 h help lines. Since 2006, BG meters and 5-10 strips/month added. Basal bolus insulin [meal time regular + bedtime NPH] 100%.

DISHA + CDiC/LFAC: 2011-ongoing: [Changing Diabetes in Children and Life for a Child with Diabetes] 242 children receiving enhanced support - 100 BG strips/ month, limited biochemical evaluations [TSH, quarterly HbA1c, annual urine albumin: creatinine ratio].

Results

I.	Type 1 Diabetes 95%;

II.	Type 2 Diabetes 1% (discontinued insulin on follow-up);

III.	Other Specific Types 4% [A. Monogenic Diabetes: Permanent Neonatal Diabetes 5 (Wolcott Rallison syndrome 1; Insulin gene mutation 1; under genetic analysis 2); Wolfram syndrome 2; D. Chronic pancreatitis 2];

IV.	Gestational Diabetes Mellitus 0%.

Age onset T1DM: 9.6y; 0-5 y: 20%; 6-10 y: 24%; 11-15 y: 29%; 16-18 y: 7%. Duration Diabetes: 8.6y;
Rural: Urban = 48: 52. Follow up 2 y.

HbA1C trend (%) Improvement: 39%; Stable: 50%; Worsening: 11%.

HbAlc         Enrollment      Latest
< 8 %	           11            	23
  8.1 - 10 %       24	        34
> 10%	           65	        43

Nephropathy trend (%) On ACE inhibitors / ARB = 25%.

Albuminuria      Enrollment           Latest
Normo	                  60	                       66
Micro                        33                  	27
Macro	                    8                   	8 

[HbA1C trend (%) and Nephropathy trend (%)]

Retinopathy: Non-proliferative: 3%; Proliferative 1%.

Hypothyroidism: 21% [At enrollment 13%; new diagnosis 9%].

Acute myocardial infarction: One 20 y girl with T1DM from age 4y.

'Growth decline" was associated with younger age [prepubertal], better initial height and weight SDS and higher prevalence of newly diagnosed hypothyroidism. On follow up, this group demonstrated decrease in height and weight SDS and lesser improvement of HbA1c.

Discussion

Childhood onset diabetes in economically underprivileged in India is almost exclusively type 1 [cf: type 2 diabetes in (affluent) children 16-46 % USA; ? India - but increasing]. Philanthropy based systematic highest possible standards of medical care, resulted in improvements in glycemic control and decrease / retardation of acute and chronic complications of childhood type 1 diabetes in a resource limited setting. Dedicated combination of physical [insulin, BG meters/strips, and medical care] and 'spiritual" [empathy and love] support can positively change the natural history of the disease and foster better health, overall wellbeing and longevity of economically underprivileged type 1 diabetes children in India and world over.