Hospital based incidence, patterns of presentation and outcome of type 1 diabetes: 12 years’ data from a tertiary care center in North India

Abstract

Increase in the incidence of Type 1 diabetes (T1D) over last several decades has been reported worldwide. There is a dearth of data on incidence/prevalence of T1D in children from India. We studied the trends in incidence of T1D amongst children attending a tertiary care pediatric hospital of North India over last 12 years and the changes in incidence, patterns of presentation and disease outcomes during this period by retrospective analysis of patient records and hospital census data. The study population comprised of 647 children with onset of T1D below 16 years who attended the hospital from April, 2001 to March, 2013. There was a consistent increase in the total number of T1D patients every year. The increase in the proportion of younger (<5 years) patients (16.2 % in 2001-02 versus 35.2 % in 2012-13) was significantly more as compared to other age categories. The percentage of patients who presented with DKA decreased every year (65 % in 2001-02 to 36.3 % in 2012-13). Younger (<5 years) patients were two to three times more likely to present in DKA than older (>15 years) patients (mean yearly percentage 60.3 versus 25 %). The proportion of patients presenting during winter months was almost double than the average of any of the 3 seasons (39 versus 20.3 %). The overall mortality was 1.7 %. In conclusion, the number of patients with T1D has shown an increase although the severity of presentation has declined. Marked seasonality in presentation indicates some unidentified environmental factors triggering the onset of disease in our patient population.

Brakes on the accelerator: the journey of accelerator hypothesis from “the missing link” to “an evolving concept”

“…6,7 Furthermore, the incidence of T1D at our hospital has also shown a significant increase over a similar time span. 8 Similar observations have been made in other studies that refute one of the key predictions of AH (Table 1, nos. 5-9, 12-16).…”

Hospitalization and mortality by diabetes mellitus in children: analysis of temporal series

“…The increase in hospitalizations due to DM in childhood had already been verified in a previous study among children under five (26) and also among the population aged 0 to 18 years (27) . Diabetic ketoacidosis and the hyperosmolar hyperglycemic state are the main severe acute complications that may occur during the course of DM1 and 2, and may be responsible for most hospitalizations and death among children and adolescents (14,27) .…”

Secular trends of body mass index in North Indian children with Type 1 diabetes do not support the Accelerator Hypothesis

“…During the past decade, we have observed a consistent annual increase in the total number of T1D patients at our centre, particularly affecting younger (<5 years) patients . Data from another nearby North Indian centre shows an alarming prevalence of T1D in children .…”