1. 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

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

3. 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

4. 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

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

6. BARIATRIC CLINIC ENDOCRINOLOGIST NUTRITIONIST SOCIAL WORKER
BARIATRIC SURGEON
PSYCHIATRIST

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

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

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

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

11. 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).

12. 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..

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

15. 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)

16. 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.

17. 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 dated )

18. 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

19. YOUNG ADULTS DIABETES CLINIC
Social worker
Physician

20. RESULTS & DISCUSSIONS Demography
GENDER
PLACE OF RESIDENCE
Age: years years

21. 3/4th of the patients exercised for 30mts daily
Occupational Status
3/4th of the patients exercised for 30mts daily

22. Insulin administration devices
Insulin Regime
Insulin Storage devices
MEAN DURATION
2-24 years
MEAN HbA1c %

23. Gender-wise distribution of Body Mass Index (BMI)
MEAN BMI kg/m2 LEAN patients

24. Nutrient intake Data
High Carbohydrates
Inadequate Proteins

25. 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

26. 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= ,-0.018)
Lower meal frequency (P=.004; CI= , )
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) 

27. 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

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

29. 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

30. ACKNOWLEDGEMENT-DIABETES CARE TEAM
UGC & IRB FUNDING THE PROJECT

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