Diabetes in young people

Dr Th Premchand Singh *

Overview of the most significant possible symptoms of diabetes :: Pix - Wikipedia/Mikael Häggström

Introduction:

Diabetes mellitus is a group of diseases characterized by high levels of glucose in the blood resulting from defects in insulin production from the islet cells of pancreas, insulin action where body's tissues not responding to insulin or both. Diabetes mellitus is diagnosed from blood glucose levels of 126mg / dl or more on fasting and 200 mg/dl or more 2 hours after glucose drink.

Diabetes if not controlled, is associated with serious complications and premature death, but timely diagnosis and treatment of diabetes can prevent or delay the onset of long-term complications like damage to the heart, kidneys, eyes, nerves, blood vessels. A number of new management strategies are available now helping children with diabetes live long and healthy lives.

The incidence of diabetes in young population is rising all over the world. A combination of genetic and environmental factors put people at risk of developing diabetes. The evidence of genetic factors for the development of diabetes in certain population are high prevalence of diabetes among certain ethnic groups like the American Indians, aborigines in Australia and the African Americans. Indians are also found genetically more prone to develop diabetes. The environmental factors are increasing obesity with increased intake of high calorie food and lack of physical activity among the children.

Types of diabetes seen among children:

1. Type 1 diabetes mellitus
2. Type 2 diabetes mellitus
3. Gestational diabetes mellitus (GDM)
4. Maturity onset diabetes of the young (MODY)
5. Latent autoimmune diabetes of adult (LADA)
6. Neonatal diabetes mellitus (NDM)

Type 1 Diabetes

Type 1 diabetes accounts for 5 to 10 percent of all diagnosed cases of diabetes, and the leading cause of diabetes in children of all ages. Type 1 diabetes results from the body's failure to produce insulin where the immune system destroys the insulin-producing beta cells of the pancreas that help to regulate blood glucose levels in the body.

Type 2 Diabetes

Type 2 diabetes mellitus results from insulin resistance where body's tissues fail to use insulin properly, and combined with an absolute or relative insulin deficiency in the body. Type 2 diabetes was believed to be a disease occurring mainly in adults older than 40 years. Now, type 2 diabetes is seen more often in young people as children become obese and inactive. Most children and adolescents diagnosed with type 2 diabetes are also insulin resistant, and have a family history of type 2 diabetes.

Gestational Diabetes:

Gestational diabetes mellitus is defined as diabetes with onset or first recognition during pregnancy. Gestational diabetes mellitus (GDM) is more common among obese women and with a family history of diabetes. Gestational diabetes mellitus (GDM) is associated with birth defects and complications to the mother and the child if not treated. Overweight women with a history of Gestational diabetes mellitus (GDM) can reduce their risk for diabetes by losing at least 5 to 7 percent of their body weight and increasing their physical activity. It is observed that Indian women have the highest frequency of gestational diabetes mellitus (GDM) compared to women of other countries.

Maturity Onset Diabetes of the Young (MODY):

Maturity Onset Diabetes of the Young (MODY) is a subtype of familial diabetes mellitus characterized by early onset with a strong family history of diabetes. Mutations in six genes cause most of the maturity onset diabetes of the young (MODY) cases. Mohan and his colleagues have reported a high prevalence of maturity onset diabetes of the young (MODY) in their study in Chennai.

Latent autoimmune diabetes of adult:

Latent autoimmune diabetes of adult (LADA) is a condition in which type 1 diabetes mellitus develops in adults. Adults with latent autoimmune diabetes of adult (LADA) are frequently initially misdiagnosed as having type 2 DM, because of the older onset of diabetes.

Neonatal diabetes:

Neonatal diabetes mellitus (NDM) is a form of diabetes that occurs in the first 6 months of life. It is a rare disease, where infants with neonatal diabetes mellitus (NDM) do not produce enough insulin, leading to an increase in blood glucose. Neonatal diabetes mellitus (NDM) can be differentiated from type 1 diabetes which occurs usually later than the first 6 months of life.

Conclusion:

More and more younger people are affected with diabetes mellitus all over the world more so in India. There has been a global effort to estimate burden of type 1 diabetes by the World Health Organization (WHO) with a Multinational Project for Childhood Diabetes in 1990 (DIAMOND). The prevalence of young type 2 diabetes is increased all over the world as a consequence of increasing body weight and lack of physical activity.

Keeping these in view, the Indian Council of Medical Research (ICMR), New Delhi, initiated the Task Force project on "Registry of People with Diabetes with Young Age at the Onset" in a number of centres across the country including Manipur.

The decision to set up a registry was aimed at understanding the youth onset diabetes in India and its regional variation. This will help the policy makers, clinicians and health experts to develop meaningful action plans to address various aspects of the disease.