Category: Diabetes/Prediabetes/Hypoglycemia

UNDERSTANDING THE TYPE -1 DIABETES MELLITUS PATIENTS IN SINGLE CENTRE STUDY

Monday, Apr 8
1:00 AM – 2:00 AM

Objective : This study was done to understand the number of insulin injection time, type of insulin and daily insulin dosage in T1D patients


Methods : Study Design: Retrospective Study , Study population: 135 Type 1 Diabetes patients identified and follow up from January 2018 to January 2019 in Ramchandani Diabetes Centre. Statistical analysis: Data was analysed using SPSS version 20 and represented as Mean + 2(Standard deviation)


Results :

The mean age 135 patients was 17.93+6.63 years with duration of diabetes 7.37+4.78 years and 47 % are male and 53% are female among diabetes patients. Among 135 patients only 1 patient is using insulin pump. Daily insulin dosage (units per day) 39.73+17.47, daily basal insulin 3.47+8.08 , Daily prandial insulin (units per day) 9.10+12.62, Daily premix insulin (units per day) 27.17+22.34. Daily injection per day is 2-4 times a day (2.63+0.77). 63 patients are using prandial insulin with 48% is used analogue and 52% is using regular insulin. 31 patients are using basal insulin with 93% using analogue and 7% is using NPH.There is no incidence of nephropathy and retinopathy in duration. In study duration 8 patients had incidence of severe hypoglycemia, 15 had DKA with hospitalization with 4 deaths due to DKA.


Details of Insulin Injection


Parameters                                                     Mean + SD


 Daily insulin dose (units per day)              39.73+17.47


Daily basal insulin (units per day)               3.47+8.08


Daily prandial insulin (units per day)          9.10+12.62


 Daily premix insulin (units per day)           27.17+22.34


 


Average daily number of SMBG


Zero 25 (18.52%) ,One 34 (25.19%),Two 60 (44.44%),Three 16 (11.85%)


Mortality after diagnosis of diabetes-No (%)


After 2 years of diagnosis of diabetes 1 (25%), After 3 years of diagnosis of diabetes ,2 (50%)


After 6 years of diagnosis of diabetes 1 (25%)


Severe hypoglycemia and DKA leading to hospitalization


Discussion :

Type 1 diabetes mellitus (T1DM) is also on increase like type 2 diabetes, even though not in the same proportion, but still with a trend of 3–5% increase/year. 1DM mostly presents as diabetic ketoacidosis (DKA) which is a common pediatric endocrine emergency. About 25-40% of the newly diagnosed T1DM children present with DKA whereas the risk of developing DKA in established T1DM children is 1-8% / patient / year.  DKA is a major complication and is associated with increased risk of morbidity and mortality.  Effective management of complications of Type 1 DM is a challenge in resource poor areas of India.


Conclusion : The majority of patients use basal insulin with high insulin units per day and DKA is the main cause of death in type 1 diabetes patients.

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G D RAMCHANDANI

Director and Diabetologist RAMCHANDANI DIABETIC CARE AND RESEARCH CENTER
Daswani Dental College KOTA RAJASTHAN INDIA 324005
Kota, Rajasthan, India

Dr. G.D.Ramchandani MD,PGDDM (UK),FACP (USA), FICP, FIACM, AFISC Senior Physician & Consultant Diabetologist Prof. & Head, Dept. of Internal Medicine : Daswani Dental College ,Kota
RAMCHANDANI DIABETES CARE AND RESEARCH CENTER

Approved for IDF : CENTRE OF EDUCATION
Partner of IDF - Project “Life For A Child” at Kota

Fellow American College of Physicians
Post Graduate Diploma in Diabetes Management (PGDDM) from
Middlesex University London (UK)
Hon. Secretary : RSSDI Rajasthan Chapter
Country (INDIA) Advisor of IDF-Project LFAC Medical & Scientific Advisor Group
Tutor of “IDF School of Diabetes”
Joint Secretary ICP (Dean’s Place) 2016
Hon. Secretary : Rajasthan Forum of ICP Fellows
Member Credential Committee of ICP 2016
Sub Editor of “Medicine Update” and “Progress in Medicine” 2016
Member American Association of Clinical Endocrinologists (AACE)
Member: ADA(USA), ATA(USA), ACP(USA), ISPAD(AUSTRALIA),AADE(USA),DSGA,RCP
Regional Faculty and Course Trainer of NDEP and PHFI at Kota
President: API Kota Chapter 2017 ,Kota Diabetic Welfare Trust
National Faculty : APICON, RSSDI, DIACON, HSICON, Diabetes India

K K Pareek

Director and Senior Physician
S N Pareek Hospital Jawahar Nagar Kota Rajasthan

President Association of Physicians of India 2019 , Chairman Scientific Program APICON 2019 held at KOCHI 7-10 Feb, Past Dean Of Indian College of Physicians 2016

GIRISH MATHUR

Director and Senior Physician
S N Pareek Hospital Jawahar Nagar KOTA, Rajasthan, India

Vice Dean Indian College of Physicians , Past Vice President Associatin of Physicians of India

Rahul Ramchandani

INTERN at VMMC New Delhi india
RAMCHANDANI DIABETES CENTER, Rajasthan, India

MBBS from Prestigious Institute of Country VMMC and Sajdarjang Hospitals New Delhi

Divyansh Mathur

INTERN at NKP Salve Institute of Medical Science and Reasearch Cente Nagpur
NKP Salve Institute of Medical Science and Reasearch Cente Nagpur

Schooling from Saint Paul School Kota