A study on drug regimen and life style modification of type 1 diabetes mellitus in children and adolescents
Abstract
Type 1 diabetes mellitus (T1DM) impacts millions of individuals worldwide and necessitates meticulous management to prevent severe long-term complications, such as cardiovascular and renal diseases, stroke, and vision impairment. People with T1DM are very different from one another. They show signs of the disease at different stages and levels of severity, and their genetic backgrounds and disease causes are also very different. This 6-month study focused on patients with T1DM at the paediatrics department of SVS Medical College and Hospital in Mahbubnagar. We collected and evaluated data from one hundred patients. This study underscores the significant impact on individuals aged 11-15 years, and our research findings reveal a higher prevalence of T1DM in males. We also conclude that obesity presents the highest risk of hyperglycaemia. Currently, the standard treatment for T1DM involves exogenous insulin substitution therapy; however, this method does not consistently provide optimal blood glucose control for many individuals. In addition to the appropriate insulin regimen, we also advocate for lifestyle management, which seeks to implement “the right therapy at the right time, for the right patient.” As previously stated, innovative strategies are essential for T1DM prevention and management. We also recommend that physical activities provide multiple benefits for individuals with T1DM. Regular physical activity improves overall well-being, aids in obesity prevention, and reduces cardiovascular risk in patients with type 1 diabetes mellitus.
Keywords:
Hyperglycaemia, lifestyle modifications, Insulin, Physical Activity, Obesity
References
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1. Xia Y., Xie Z., Huang G., Zhou Z. (2019) Incidence and trend of type 1 diabetes and the underlying environmental determinants. Diabetes Metab. Res. Rev. 35:e3075.
2. Ward Z.J., Yeh J.M., Reddy C.L., Gomber A., Ross C., Rittiphairoj T., Manne-Goehler J., Abdalla A.T., Abdullah M.A., Ahmed A., et al. (2022) Estimating the total incidence of type 1 diabetes in children and adolescents aged 0–19 years from 1990 to 2050: A global simulation-based analysis. Lancet Diabetes Endocrinol. 10:848–858.
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9. Cavalot F., Petrelli A., Traversa M., Bonomo K., Fiora E., Conti M., Anfossi G., Costa G., Trovati M. (2006) Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study. J. Clin. Endocrinol. Metab. 91:813–819.
10. Ceriello A. (2004) Postprandial Glucose Regulation and Diabetic Complications. Arch. Intern. Med. 164:2090.
11. Smart C.E., Annan F., Higgins L.A., Jelleryd E., Lopez M., Acerini C.L. ISPAD (2018) Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes. Pediatr. Diabetes. 19:136–154.
12. Vadagam N, Haridasyam SB, Venkatanarayana M, Lakka NS and Chinnakadoori SR: Separation and quantitative estimation of stereo-selective enantiomers of montelukast in pharmaceutical drug substance and tablets dosage forms by using stability-indicating normal phase-HPLC method. Chirality 2023; 35(12): 952-965.
13. Vadagam N, Haridasyam SB, Venkatanarayana M, Lakka NS and Chinnakadoori SR: Separation and quantitation ofvalacyclovir enantiomers using stability-indicating chiral liquid chromatography method with a chiral stationary phase of amylose tris-(3,5-dimethylphenylcarbamate). Separation Science Plus 2023; 6(12): 2300145
14. Stenvers D.J., Schouten L.J., Jurgens J., Endert E., Kalsbeek A., Fliers E., Bisschop P.H. (2014) Breakfast replacement with a low-glycaemic response liquid formula in patients with type 2 diabetes: A randomised clinical trial. Br. J. Nutr. 112:504–512.
15. Lobos D.R., Vicuña I.A., Novik V., Vega C.A. (2017) Effect of high and low glycemic index breakfast on postprandial metabolic parameters and satiety in subjects with type 2 diabetes mellitus under intensive insulin therapy: Controlled clinical trial. Clin. Nutr. ESPEN. 20:12–16
16. Pasham M, Haridasyam SB, Vadagam N, Praveen Boppy NVVD, Chinnakadoori SR and Lakka NS: Separation and quantification of organic-related impurities of betaadrenergic receptor blocking agent propranolol in pharmaceutical solid dosage forms: Impurity profiling using stability-indicating HPLC method. Separation Science Plus 2023;2300159.
17. Praveen Boppy NVVD, Haridasyam SB, Vadagam N, Venkatanarayana M, Chinnakadoori SR and Lakka NS: Separation and quantification of organic-related impurities of anti-histamine drug hydroxyzine in pharmaceutical dosage forms using stability-indicating high-performance liquid chromatography, liquid chromatography-mass spectrometry, and high-resolution mass spectrometry techniques, Separation Science Plus 2024; 2300157
18. Chang C.R., Francois M.E., Little J.P. (2019) Restricting carbohydrates at breakfast is sufficient to reduce 24-hour exposure to postprandial hyperglycemia and improve glycemic variability. Am. J. Clin. Nutr. 109:1302–1309
19. De Carvalho C.M., de Paula T.P., Viana L.V., Machado V.M., de Almeida J.C., Azevedo M.J. (2017) Plasma glucose and insulin responses after consumption of breakfasts with different sources of soluble fiber in type 2 diabetes patients: A randomized crossover clinical trial. Am. J. Clin. Nutr. 106:1238–1245.
20. Martínez-González M.Á., De la Fuente-Arrillaga C., Nunez-Cordoba J.M., Basterra-Gortari F.J., Beunza J.J., Vazquez Z., Benito S., Tortosa A., Bes-Rastrollo M. (2008) Adherence to Mediterranean diet and risk of developing diabetes: Prospective cohort study. BMJ. 336:1348–1351
21. Bell K.J., Smart C.E., Steil G.M., Brand-Miller J.C., King B., Wolpert H.A. (2015) Impact of Fat, Protein, and Glycemic Index on Postprandial Glucose Control in Type 1 Diabetes: Implications for Intensive Diabetes Management in the Continuous Glucose Monitoring Era. Diabetes Care. 38:1008–1015.
22. Vlachos D., Malisova S., Lindberg F.A., (2020) Karaniki G. Glycemic Index (GI) or Glycemic Load (GL) and Dietary Interventions for Optimizing Postprandial Hyperglycemia in Patients with T2 Diabetes: A Review. Nutrients. 12:1561.
23. Mazzocchi A., Leone L., Agostoni C., Pali-Schöll I. (2019) The Secrets of the Mediterranean Diet. Does [Only] Olive Oil Matter? Nutrients. 11:2941.
24. Smart C.E., Evans M., O’connell S.M., McElduff P., Lopez P.E., Jones T.W., Davis E.A., King B.R. (2013) Both Dietary Protein and Fat Increase Postprandial Glucose Excursions in Children with Type 1 Diabetes, and the Effect Is Additive. Diabetes Care. 36:3897–3902.
25. Lakka NS, Kuppan C, Vadagam N, Ravinathan P, Chepuri K and Chinnakadoori SR: Molecular docking, in-vitro anticancer evaluation and ADME profiling of 7-Oxo Midostaurin. Journal of Molecular Structure 2023; 1293:136159.
26. Vadagam N, Haridasyam SB, Venkatanarayana M, Lakka NS and Chinnakadoori SR: Separation and simultaneous estimation of enantiomers and Diastereomers of muscarinic receptor antagonist Solifenacin using stabilityindicating Normal-phase HPLC technique with chiral stationary phase amylose tris-(3,5- dimethylphenylcarbamate). Chirality 2024; 36(2): e23632.
27. Neu A., Behret F., Braun R., Herrlich S., Liebrich F., Loesch-Binder M., Schneider A., Schweizer R. (2015) Higher glucose concentrations following protein- and fat-rich meals—The Tuebingen Grill Study: A pilot study in adolescents with type 1 diabetes. Pediatr. Diabetes. 16:587–591.
28. Abdou M., Hafez M.H., Anwar G.M., Fahmy W.A., Abd Alfattah N.M., Salem R.I., Arafa N. (2021) Effect of high protein and fat diet on postprandial blood glucose levels in children and adolescents with type 1 diabetes in Cairo, Egypt. Diabetes Metab. Syndr. Clin. Res. Rev. 15:7–12.
29. American Diabetes Association 9. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes—2020. Diabetes Care. 2020;43(Supplement 1):S98.
30. Beck RW, Bergenstal RM, Laffel LM, Pickup JC. (2019) Advances in technology for management of type 1 diabetes. Lancet. 394(10205):1265–1273.
31. Miller RG, Secrest AM, Sharma RK, Songer TJ, Orchard TJ. (2012) Improvements in the life expectancy of type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications study cohort. Diabetes. 61(11):2987–2992
29. Weinstock RS, Schütz-Fuhrmann I, Connor CG, et al. (2016) Type 1 diabetes in older adults:comparing treatments and chronic complications in the United States T1D Exchange and the German/Austrian DPV registries. Diabetes Res Clin Pract. 122:28–37.
30. Petrie JR, Sattar N. (2019) Excess cardiovascular risk in type 1 diabetes mellitus. Circulation. 139(6):744–747.
31. Yasmin, Masuma et al (2022) Model of care for Type 1 diabetes in India: Integrated approach for its incorporation in future national health care policy. The Lancet Regional Health - Southeast Asia, Volume 3, 100014
32. Maiti, S., Akhtar, S., Upadhyay, A.K. et al. ((2023). Socioeconomic inequality in awareness, treatment and control of diabetes among adults in India: Evidence from National Family Health Survey of India (NFHS), 2019–2021. Sci Rep 13, 297.
33. Kandemir N, Vuralli D,Ozon A, et al. (2024) Epidemiology of type 1 diabetesmellitus in children and adolescents: A 50-year,single-center experience. Journal of Diabetes.;16(5): e13562.
34. Chiang JL, Maahs DM, Garvey KC, Hood KK, Laffel LM, Weinzimer SA, Wolfsdorf JI, Schatz D. (2018) Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association. Diabetes Care. 41(9):2026-2044.
2. Abela A.G., Fava S. (2021) Why is the Incidence of Type 1 Diabetes Increasing? Curr. Diabetes Rev.;17:22–34.
3. Zimmet P., Alberti K.G., Magliano D.J., Bennett P.H. (2016) Diabetes mellitus statistics on prevalence and mortality: Facts and fallacies. Nat. Rev. Endocrinol. 12:616–622.
1. Xia Y., Xie Z., Huang G., Zhou Z. (2019) Incidence and trend of type 1 diabetes and the underlying environmental determinants. Diabetes Metab. Res. Rev. 35:e3075.
2. Ward Z.J., Yeh J.M., Reddy C.L., Gomber A., Ross C., Rittiphairoj T., Manne-Goehler J., Abdalla A.T., Abdullah M.A., Ahmed A., et al. (2022) Estimating the total incidence of type 1 diabetes in children and adolescents aged 0–19 years from 1990 to 2050: A global simulation-based analysis. Lancet Diabetes Endocrinol. 10:848–858.
3. American Diabetes Association (2014) Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 37:S81–S90.
4. Beck R.W., Bergenstal R.M., Laffel L.M., Pickup J.C. (2019) Advances in technology for management of type 1 diabetes. Lancet. 394:1265–1273.
5. Sims E.K., Carr A.L.J., Oram R.A., DiMeglio L.A., Evans-Molina C. (2021) 100 years of insulin: Celebrating the past, present and future of diabetes therapy. Nat. Med. 27:1154–1164.
6. Mańkiewicz-Żurawska I., Jarosz-Chobot P. (2019) Nutrition of children and adolescents with type 1 diabetes in the recommendations of the Mediterranean diet. Pediatr. Endocrinol. Diabetes Metab. 25:74–80.
7. Node K., Inoue T. (2009) Postprandial hyperglycemia as an etiological factor in vascular failure. Cardiovasc. Diabetol. 8:23.
8. Leiter L.A., Ceriello A., Davidson J.A., Hanefeld M., Monnier L., Owens D.R., Tajima N., Tuomilehto J., Group I.G. (2005) Postprandial glucose regulation: New data andnew implications. Clin. Ther. 27:S42–S56
9. Cavalot F., Petrelli A., Traversa M., Bonomo K., Fiora E., Conti M., Anfossi G., Costa G., Trovati M. (2006) Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study. J. Clin. Endocrinol. Metab. 91:813–819.
10. Ceriello A. (2004) Postprandial Glucose Regulation and Diabetic Complications. Arch. Intern. Med. 164:2090.
11. Smart C.E., Annan F., Higgins L.A., Jelleryd E., Lopez M., Acerini C.L. ISPAD (2018) Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes. Pediatr. Diabetes. 19:136–154.
12. Vadagam N, Haridasyam SB, Venkatanarayana M, Lakka NS and Chinnakadoori SR: Separation and quantitative estimation of stereo-selective enantiomers of montelukast in pharmaceutical drug substance and tablets dosage forms by using stability-indicating normal phase-HPLC method. Chirality 2023; 35(12): 952-965.
13. Vadagam N, Haridasyam SB, Venkatanarayana M, Lakka NS and Chinnakadoori SR: Separation and quantitation ofvalacyclovir enantiomers using stability-indicating chiral liquid chromatography method with a chiral stationary phase of amylose tris-(3,5-dimethylphenylcarbamate). Separation Science Plus 2023; 6(12): 2300145
14. Stenvers D.J., Schouten L.J., Jurgens J., Endert E., Kalsbeek A., Fliers E., Bisschop P.H. (2014) Breakfast replacement with a low-glycaemic response liquid formula in patients with type 2 diabetes: A randomised clinical trial. Br. J. Nutr. 112:504–512.
15. Lobos D.R., Vicuña I.A., Novik V., Vega C.A. (2017) Effect of high and low glycemic index breakfast on postprandial metabolic parameters and satiety in subjects with type 2 diabetes mellitus under intensive insulin therapy: Controlled clinical trial. Clin. Nutr. ESPEN. 20:12–16
16. Pasham M, Haridasyam SB, Vadagam N, Praveen Boppy NVVD, Chinnakadoori SR and Lakka NS: Separation and quantification of organic-related impurities of betaadrenergic receptor blocking agent propranolol in pharmaceutical solid dosage forms: Impurity profiling using stability-indicating HPLC method. Separation Science Plus 2023;2300159.
17. Praveen Boppy NVVD, Haridasyam SB, Vadagam N, Venkatanarayana M, Chinnakadoori SR and Lakka NS: Separation and quantification of organic-related impurities of anti-histamine drug hydroxyzine in pharmaceutical dosage forms using stability-indicating high-performance liquid chromatography, liquid chromatography-mass spectrometry, and high-resolution mass spectrometry techniques, Separation Science Plus 2024; 2300157
18. Chang C.R., Francois M.E., Little J.P. (2019) Restricting carbohydrates at breakfast is sufficient to reduce 24-hour exposure to postprandial hyperglycemia and improve glycemic variability. Am. J. Clin. Nutr. 109:1302–1309
19. De Carvalho C.M., de Paula T.P., Viana L.V., Machado V.M., de Almeida J.C., Azevedo M.J. (2017) Plasma glucose and insulin responses after consumption of breakfasts with different sources of soluble fiber in type 2 diabetes patients: A randomized crossover clinical trial. Am. J. Clin. Nutr. 106:1238–1245.
20. Martínez-González M.Á., De la Fuente-Arrillaga C., Nunez-Cordoba J.M., Basterra-Gortari F.J., Beunza J.J., Vazquez Z., Benito S., Tortosa A., Bes-Rastrollo M. (2008) Adherence to Mediterranean diet and risk of developing diabetes: Prospective cohort study. BMJ. 336:1348–1351
21. Bell K.J., Smart C.E., Steil G.M., Brand-Miller J.C., King B., Wolpert H.A. (2015) Impact of Fat, Protein, and Glycemic Index on Postprandial Glucose Control in Type 1 Diabetes: Implications for Intensive Diabetes Management in the Continuous Glucose Monitoring Era. Diabetes Care. 38:1008–1015.
22. Vlachos D., Malisova S., Lindberg F.A., (2020) Karaniki G. Glycemic Index (GI) or Glycemic Load (GL) and Dietary Interventions for Optimizing Postprandial Hyperglycemia in Patients with T2 Diabetes: A Review. Nutrients. 12:1561.
23. Mazzocchi A., Leone L., Agostoni C., Pali-Schöll I. (2019) The Secrets of the Mediterranean Diet. Does [Only] Olive Oil Matter? Nutrients. 11:2941.
24. Smart C.E., Evans M., O’connell S.M., McElduff P., Lopez P.E., Jones T.W., Davis E.A., King B.R. (2013) Both Dietary Protein and Fat Increase Postprandial Glucose Excursions in Children with Type 1 Diabetes, and the Effect Is Additive. Diabetes Care. 36:3897–3902.
25. Lakka NS, Kuppan C, Vadagam N, Ravinathan P, Chepuri K and Chinnakadoori SR: Molecular docking, in-vitro anticancer evaluation and ADME profiling of 7-Oxo Midostaurin. Journal of Molecular Structure 2023; 1293:136159.
26. Vadagam N, Haridasyam SB, Venkatanarayana M, Lakka NS and Chinnakadoori SR: Separation and simultaneous estimation of enantiomers and Diastereomers of muscarinic receptor antagonist Solifenacin using stabilityindicating Normal-phase HPLC technique with chiral stationary phase amylose tris-(3,5- dimethylphenylcarbamate). Chirality 2024; 36(2): e23632.
27. Neu A., Behret F., Braun R., Herrlich S., Liebrich F., Loesch-Binder M., Schneider A., Schweizer R. (2015) Higher glucose concentrations following protein- and fat-rich meals—The Tuebingen Grill Study: A pilot study in adolescents with type 1 diabetes. Pediatr. Diabetes. 16:587–591.
28. Abdou M., Hafez M.H., Anwar G.M., Fahmy W.A., Abd Alfattah N.M., Salem R.I., Arafa N. (2021) Effect of high protein and fat diet on postprandial blood glucose levels in children and adolescents with type 1 diabetes in Cairo, Egypt. Diabetes Metab. Syndr. Clin. Res. Rev. 15:7–12.
29. American Diabetes Association 9. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes—2020. Diabetes Care. 2020;43(Supplement 1):S98.
30. Beck RW, Bergenstal RM, Laffel LM, Pickup JC. (2019) Advances in technology for management of type 1 diabetes. Lancet. 394(10205):1265–1273.
31. Miller RG, Secrest AM, Sharma RK, Songer TJ, Orchard TJ. (2012) Improvements in the life expectancy of type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications study cohort. Diabetes. 61(11):2987–2992
29. Weinstock RS, Schütz-Fuhrmann I, Connor CG, et al. (2016) Type 1 diabetes in older adults:comparing treatments and chronic complications in the United States T1D Exchange and the German/Austrian DPV registries. Diabetes Res Clin Pract. 122:28–37.
30. Petrie JR, Sattar N. (2019) Excess cardiovascular risk in type 1 diabetes mellitus. Circulation. 139(6):744–747.
31. Yasmin, Masuma et al (2022) Model of care for Type 1 diabetes in India: Integrated approach for its incorporation in future national health care policy. The Lancet Regional Health - Southeast Asia, Volume 3, 100014
32. Maiti, S., Akhtar, S., Upadhyay, A.K. et al. ((2023). Socioeconomic inequality in awareness, treatment and control of diabetes among adults in India: Evidence from National Family Health Survey of India (NFHS), 2019–2021. Sci Rep 13, 297.
33. Kandemir N, Vuralli D,Ozon A, et al. (2024) Epidemiology of type 1 diabetesmellitus in children and adolescents: A 50-year,single-center experience. Journal of Diabetes.;16(5): e13562.
34. Chiang JL, Maahs DM, Garvey KC, Hood KK, Laffel LM, Weinzimer SA, Wolfsdorf JI, Schatz D. (2018) Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association. Diabetes Care. 41(9):2026-2044.
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21/02/2025
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Samreen, S. L., Kavitha, S., Khanam, R., T, M. R., Fathima, K., naaz, S., & Soumya, P. (2025). A study on drug regimen and life style modification of type 1 diabetes mellitus in children and adolescents. The Journal of Multidisciplinary Research, 5(1), 7-13. https://doi.org/10.37022/tjmdr.v5i1.664
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