CHRISTIAN MEDICAL COLLEGE & HOSPITAL, VELLORE, INDIA Low Protein is associated with poor glycaemic control in young adults with Type 1 Diabetes mellitus Department of Endocrinology, Diabetes and Metabolism CHRISTIAN MEDICAL COLLEGE & HOSPITAL, VELLORE, INDIA Mini Joseph, Asha HS, Riddhi DG, Vijayalakshmi and Nihal Thomas

Christian Medical College, Vellore South India 2600 bedded, Tertiary care Educational & Research centre Started in 1900 - Dr Ida S Scudder Caters to neighbouring States & countries.

DEPARTMENT OF ENDOCRINOLOGY, DIABETES & METABOLISM GENERAL DIABETES CLINIC SPECIAL CLINICS FOOT CLINIC GDM CLINIC YOUNG ADULTS TYPE 1CLINIC EYE CLINIC BARIATRIC CLINIC THYROID CLINIC PITUITARY CLINIC OUT REACH PROGRAMS SCHOOL PROGRAMS HEALTH CAMPS PUBLIC AWARENESS ACTIVITIES

Integrated approach Endocrinologist is supported by a team Diabetes educators Dietitians Social workers Physiotherapists Pharmacists Co-ordinators/facilitators EACH MEMBER IS IMPORTANT IN PATIENT CARE

INTEGRATED DIABETES FOOT CLINIC PMR physician Endocrine Physician Vascular surgeon Prosthetist and orthotist Diabetes Podiatric Nurse Physiotherapist

BARIATRIC CLINIC ENDOCRINOLOGIST NUTRITIONIST SOCIAL WORKER BARIATRIC SURGEON PSYCHIATRIST

Reshape Discussion at Scudder Junior School SCHOOL HEALTH AWARENESS PROGRAM AND EDUCATION- SPADES 2016- “HEALTHY SNACKS” Reshape Discussion at Scudder Junior School Healthy Class Award

More than 80 Camps conducted over last 6 years.. Covering over 15,000 people..

World Diabetes Day- Public Awareness Programs.. DIABETES-AN EPIDEMIC

IDF 2015 - 415 million worldwide – Diabetes mellitus 1 in 11 adults have diabetes (IDF Atlas 2015) According to the International Diabetes Federation 2015….

Prevalence of DM IDF 2015-USA has the highest (11%). China & India - highest total numbers of people with DM — 110 and 69 million respectively In the GULF there are over ONE million DM cases in 2015 (IDF).

This is the geographical distribution of the prevalence of Diabetes projected for the year 2025…that is in in 10 years time…You can see that the Gulf countries will have the highest prevalence of diabetes, and in that the United Arab Emirates. That is 1 in 5 persons..

T1DM - Commonest metabolic disorders of childhood 542,000 children worldwide are affected (IDF 2015)

T1DM… T1DM occurs- autoimmune destruction of beta cells predisposed by genetic and precipitated by environmental determinants India has largest incidence (2013) of T1DM- South-East Asia Region (SEAR South India -10.5/100,000/year (below 15 years of age in the four year period from 1991 to 1994)

To study the nutrient adequacy of their diets OBJECTIVES To study the demographic details, anthropometric, clinical and biochemical parameters of Type 1 DM patients To study the nutrient adequacy of their diets To study the association of above factors with metabolic control (HbA1C) in these patients.

Methodology All patients who visited the T1DM clinic 3 months duration study Male/female 18-43 years of age No chronic illness/psychiatric infirmities/not pregnant Approval- IRB Min. No. 9547 dated 22.07.2015)

Tools used Questionnaire to collect data on Socio-economic background Demographic details Anthropometric measures Clinical & Biochemical parameters was updated from the medical records Dietary Assessment using Food diary 24 hour recall Statistical analysis using SPSS 21

YOUNG ADULTS DIABETES CLINIC Social worker Physician

RESULTS & DISCUSSIONS Demography GENDER PLACE OF RESIDENCE Age: 25.08 + 7 years 26.47 + 6 years

3/4th of the patients exercised for 30mts daily Occupational Status 3/4th of the patients exercised for 30mts daily

Insulin administration devices Insulin Regime Insulin Storage devices MEAN DURATION 2-24 years MEAN HbA1c 9.1 + 2.7%

Gender-wise distribution of Body Mass Index (BMI) MEAN BMI 20.6 + 3.0 kg/m2 LEAN patients

Nutrient intake Data High Carbohydrates Inadequate Proteins

Nutritional intake of T1DM patients Meal frequency 3 meals 3 meals + 1 snack 3 meals + 2 snacks 3 meals + > 3 snacks   †Daily servings of fibre rich foods Poor (< 2 servings) Fair (3-4 servings) Adequate (>5 servings) Males (%) 7.8 14.1 70.3 60.9 23.5 15.6 Females (%) 4 14 18 64 58 28

Univariate & Multivariate Regression analysis: HbA1C & independent factors Higher HbA1C correlated with: Longer duration of diabetes (P=0.002; CI=0.011, 0.048) Higher per cent of carbohydrates in diet (P=0.046; CI=0 .000, 0.157) Low protein intake (P=0.045; CI= -1.664,-0.018) Lower meal frequency (P=.004; CI= -0.876, -0.170) Inadequate exercise (P=0.047; CI=0.018, 2.715) In the multivariate regression model, adjusted for confounding factors like gender, age and BMI, significant association with HbA1C…. Longer duration of diabetes (P=0.000) Lower protein intake (P=0.022) 

Summary Majority came from the rural, lower SE Group Had a poor nutritional intake Half the patients were malnourished Glycaemic control (HbA1C) was not affected by Economic strata- Fund IDF-LFAC & Marjorie’s Occupation Level of education- reflects fact that academic knowledge does not always translate into disease awareness

SUMMARY Two major factors that affected glycaemic control in our group of patients : Longer duration of Diabetes Low Protein intake

CONCLUSION The diabetes care team should continue to educate the patients on the principles of good nutrition practices Each visit to the hospital is an opportunity to equip the patient to control their Diabetes status

ACKNOWLEDGEMENT-DIABETES CARE TEAM UGC & IRB FUNDING THE PROJECT

VELLORE FORT, Tamil Nadu, S India THANKYOU VELLORE FORT, Tamil Nadu, S India THE SITE WHERE THE FIRST INDIAN FREEDOM STRUGGLE INITIATED