Department of Endocrinology, Diabetes and Metabolism

1. 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 1900 - 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 NUTRITIONIST SOCIAL WORKER ENDOCRINOLOGIST BARIATRIC SURGEON PSYCHIATRIST

7. SCHOOL HEALTH AWARENESS PROGRAM AND EDUCATION- SPADES 2016- “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)

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).

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. 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. 9547 dated 22.07.2015)

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 & DISCUSSIONSDemography PLACE OF RESIDENCE GENDER Age: 25.08 +7 years 26.47 +6 years

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

22. Insulin administration devices Insulin Regime Insulin Storage devices

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

24. Nutrient intake Data • High Carbohydrates • Inadequate Proteins

25. Nutritional intake of T1DM patients

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= -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)

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