Medical nutrition therapy of pediatric type 1 diabetes mellitus in India: Unique aspects and challenges

Abstract

Medical nutrition therapy (MNT) is a vital aspect of management of type 1 diabetes mellitus (T1DM) and should be tailored to ethnic and family traditions and the socioeconomic and educational status of the patient. In this article, we discuss the unique aspects of MNT in children and adolescents with T1DM in the Indian setting, with focus on the challenges faced by patients, dieticians and physicians and how these can be overcome. The authors reviewed the available literature on MNT in T1DM from India and prepared the document based on their vast collective clinical experience in treating patients with T1DM from different regions in India. Indian diets are predominantly carbohydrate‐based with high glycemic index (GI) and low protein content. Various methods are available to increase the protein and fiber content and reduce the GI of food in order to limit glycemic excursions. Insulin regimens need to be tailored to the child's school timings, meal schedule, and the availability of a responsible adult to supervise/administer insulin. All patients, irrespective of economic and education background, should be taught the broad principles of healthy eating, balanced diet and carbohydrate counting. There are various barriers to dietary compliance, including joint family system, changing lifestyles, and other factors which need to be addressed. There is a need to customize dietary management according to patient characteristics and needs and develop standardized patient educational material on principles of healthy eating in various regional languages.

‘Old Is Gold’: How Traditional Indian Dietary Practices Can Support Pediatric Diabetes Management

“…Peanuts ('poor man's protein') can be roasted, fried, or steamed and are very popular as snacks or added to dishes, enhancing protein and healthy fat content. Adding whole or crushed roasted peanuts to vegetables and cerealbased savory grain items, or having peanut chutney with idli or dosa, as is commonly done, lowers the GI [105]. Many preparations use fresh coconut, which adds fiber, medium-chain triglycerides, and micronutrients [106].…”

“…PwD should be as careful about sodium intake as the general population [105]. A range of spices widely used in Indian cooking (cumin, cardamom, lemon, tamarind, kokum, vinegar, onion, garlic, and fresh/dry raw mango) commonly replace salt as taste enhancers and therefore reduce the need for salt.…”

“…Ripe bananas were also often given as prasad: the comparatively higher GI was particularly helpful after fasting. Similar principles can be followed during parties and functions, with wise choices, small portions, and covering extra carbohydrates, protein, and fat with adequate extra insulin and extra physical activity [105]. Some examples of festive foods of India are provided in Supplementary Table S5 [1,121].…”

Childhood and adolescent diabetes in the Indian subcontinent: A glass half full

“…23,24 This results in inade- traditions, which have to be factored in during education. 25 India has 22 major languages and more than 500 dialects, posing challenges for diabetes education programs and creation of education tools. Low community awareness about childhood diabetes results in poor support at school with regard to injections, food and participation in activities, and discrimination in jobs and marriage.…”

“…The hot tropical climate makes it a challenge to ensure a cold chain for insulin, particularly for families who cannot afford a refrigerator. The extensive geography of the subcontinent brings with it diversity of foods and traditions, which have to be factored in during education 25 . India has 22 major languages and more than 500 dialects, posing challenges for diabetes education programs and creation of education tools.…”