Andhra Pradesh: School children in capital prone to diabetes

Vijayawada: The school children in the Capital city and its surrounding areas are found to be having either pre-diabetes or diabetes.

A study carried out by Dr. T. Sateesh Chandra, a city-based endocrinologist and diabetes specialist, has observed that 30 per cent of the schoolchildren, in the age group of 10-12 years in this region, are found to be in either of the stages.
"It is not just because of their economic background that they have the disease," Dr. Sateesh Chandra observed and added that increasing stress-levels and irregular working hours are making them diabetic.

According to the Indian Journal of Endocrinology and Metabolism (IJEM), it is estimated that India has 97,700 children with Type 1 Diabetes Mellitus (T1DM). A study of 30 children with insulin-dependent diabetes, at the diagnosis age less than 15 years, conducted in 1992, reported a prevalence of 0.26/1,000 children. 
The peak age at diagnosis was 12 years. This was the first population-based study of prevalence of insulin-dependent diabetes in South India and shows that insulin-dependent diabetes is not rare and is higher than that reported from many other Asian countries. 

Basing on this study, Dr. T. Sateesh Chandra, of Vijayawada, has carried out a micro-study confining the study area to Vijayawada and its surroundings. "It is astonishing to note that at least 5 school going children on every consecutive day are visiting the diabetes specialists in the city," Dr. Chnadra observed. It is an alarming situation, wherein the department of school education, sports, and managements of corporate schools should sit and think, his study has suggested. 

"When there are timings for places of worship, entertainment malls, movie theatres and for that matter even for bars, why not the same rule is applicable for schools," Dr. Sateesh Chandra questioned. Forcing children to stay back till 7 pm or 8 pm, from morning 8 am, in the packed rooms without any sports and physical activity would certainly attract the environment to become diabetic, he observed. 

Diabetes increases risk of dental caries in children
It was also noticed that a majority of the school going children in the Capital region are suffering from oral problems, due to diabetes. 

"The diabetes-affected children will have increased risk of dental caries due to salivary hypofunction," said pedodontist and researcher Dr. Ambati Naga Radha Krishna, who also added that accelerated tooth eruption is indicated with increasing age. Gingivitis with high risk of periodontal disease (poor control increases risk), salivary gland dysfunction leading to xerostomia, Impaired or delayed wound healing, taste dysfunction and oral candidiasis, are the other areas observed among the diabetes-affected children, in the study carried out by Dr. Radha Krishna.

However, there are some suggestions from Dr. Ghanashyam Prasad, relating to such problems among diabetes-affected children. He has suggested to ensure glycemic control at the appointment time. His study has suggested that the Haemoglobin A1c (HbA1c) test is indicating 8, among majority of the school going children, in the Capital region, following their packed schedules and lack of physical activity. He has suggested to the departments concerned to review the status of dental problems among diabetes- affected schoolchildren, at frequent intervals.

Haemoglobin A1c (HbA1c)  less than 7 indicates good control in previous 3 months, and greater than 8 indicates very poor control, Dr. Ghanshyam Prasad has observed. He has suggested to ensure that the child has eaten a meal and taken usual medication prior to treatment. 

"Monitoring oral disease progression, oral hygiene, and diet habits frequently is highly essential, in these diabetes-affected children," Dr. Ghanshyam Prasad suggests. 

 He also suggested to the school education department to organise the oral care in frequent intervals, as it is observed that there is the increase in the number of children suffering with candidiasis. Such children should be prescribed sugar-free Nystatin.

For children with recurrent HSV (Herpes Simplex Virus) infection, management with systemic and topical medications is indicated to decrease frequency and duration of infection, according to Dr. Ghanshyam Prasad's study. 

"Increased oral comfort will improve child's ability to manage diabetes through diet," he observed and added considering antibiotic coverage for children with poorly-controlled diabetes, since there may be increased risk of infections and delayed wound healing.  

He suggested that treatment for oral infection and ulceration aggressively is needed among diabetes-affected children.