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Objective: Data regarding the efficacy and feasibility of telemedicine services in type 1 diabetes (T1D) are sparse in India. This study was planned to assess non-inferiority of glycemic control and diabetes knowledge score after outreach care via telemedicine., Methods: The study enrolled persons with T1D (age £ 25 years). The paramedical members of our multidisciplinary team (MDT) rendered their routine clinic care at the outreach center. The doctor's consultation in each session was via Zoom platform. A change in HbA1c level and diabetes knowledge score was assessed at last visit (at 6 months)., Results: A total of 59 persons with T1D were included. The median, (IQR) HbA1c (%) reduced significantly at 6 months compared to baseline; 8.0 (7.2, 8.7) vs 8.47 (7.3, 9.2), P = 0.043. The mean (SD) diabetes knowledge score improved from 61.2 (13.1) to 64.9 (11.7); P = 0.022. Median (IQR) saving per family was Rs 1500 (1000, 2500) and 10 (5, 24) hours per visit., Conclusion: Tele-diabetes care was effective in managing T1D in our region and assisted in outreach care by the MDT.

Objective: To document glycemic patterns during school and sleep by continuous glucose monitoring system (CGMS) in school-going children with type 1 diabetes. To correlate glycemia with meal composition., Methods: Patients with type 1 diabetes (n = 22) aged 4 to 19 years were enrolled. Food recording was taught, and a retrospective CGMS sensor was worn by them for 6 to 14 days. Dietary composition and glycemic patterns during school and sleep were analyzed., Results: The mean (SD) of dietary carbohydrate was 62.9 (9.2)% of daily calories (high) and protein 13 (2.5) % (low). Sensor glucose > 180 mg/dL (hyperglycemia) was detected on 73% of 139 school day CGMS records and involved 58 % of the school time. Sensor glucose < 70 mg/dL (hypoglycemia) was present on 45% of 172 nights. Time below range was 20 (25) %. Mean (SD) protein content (g) of dinner was significantly higher when it included lentil (dal) than without [20.4 (9.7) vs 15.3 (8.3); P < 0.001]. Hypoglycemia occurred less often on nights with vs without dal for dinner (42.1% vs 51.7%; P = 0.048)., Conclusions: Hyperglycemia during school hours was notable. The inclusion of lentil (dal) in the night meal in the traditional diet may reduce nocturnal hypoglycemia.

Objective: To study glycemic control, mortality and long-term complications in children with type 1 diabetes (T1D)., Design: Cross-sectional study., Setting: Referral centre at a government teaching hospital., Participants: Patients with T1D with age £18 years at onset., Methods: We retrospectively collected demographic data from computer records from 1991 to 2015. Prospective study for outcomes was conducted between 2012 and 2016., Main Outcome Measures: Mortality rate, glycosylated hemoglobin (HbA1c), and microvascular complication rate., Results: The proportion of T1D patients (n=512) <5 years of age at onset was 18.6% between 1995 and 2004, and 24.2% in 2005-2014 (P<0.001). Twenty eight patients had died out of 334 whose living status was known (mortality 1.1 per 100 patient-years over 2549 patient-years follow up). Median (range) HbA1c (n=257) was 8.3% (5.1-15.0%). At least one episode of severe hypoglycemia (coma/seizure/inability to assist self) had occurred in 22.8% patients over two years. Hypertension was present in 11.7% patients. Microvascular complications screen in 164 eligible patients [median (range) age 20 (8-45) y and duration of diabetes 9.1 (5-30) y] showed diabetic nephropathy in 3.0%, proliferative retinopathy in 3.6% and LDL cholesterol >100 mg/dL in 34% patients., Conclusions: The mortality rate and prevalence of hypertension were high, given the short duration of diabetes of the patients. The proportion of patients with age ≤5 years at onset of diabetes has increased at our center.

Objective: To assess feasibility and recall rates for newborn screening for congenital hypothyroidism, galactosemia and biotinidase deficiency in a predominantly rural and inner city population in and around the City of Lucknow in Uttar Pradesh, India., Design: Prospective observational study., Setting: Two tertiary-care and 5 district hospitals in and around Lucknow., Participants: All babies born in above hospitals during the study period., Methods: Heel prick samples were collected after 24 hours of life. Dried blood spot TSH, total galactose and biotinidase were assayed by immunofluorometry. Age related cut-offs were applied for recall for TSH. For galactosemia and biotinidase deficiency, manufacturer-suggested recall cut-offs used initially were modified after analysis of initial data., Main Outcome Measure: Recall rate for hypothyroidism, galactosemia and biotinidase deficiency., Results: Screening was carried out for 13426 newborns, 73% of all deliveries. Eighty-five percent of those recalled for confirmatory sampling responded. Using fixed TSH cut off of 20 mIU/L yielded high recall rate of 1.39%, which decreased to 0.84% with use of age-related cut-offs. Mean TSH was higher in males, and in low birth weight and vaginally delivered babies. Eleven babies had congenital hypothyroidism. Recall rates with modified cut-offs for galactosemia and biotinidase deficiency were 0.32% and 0.16%, respectively., Conclusions: An outreach program for newborn screening can be successfully carried out in similar socio-cultural settings in India. For hypothyroidism, the high recall rate due to early discharge was addressed by age-related cut-offs.

Objective: To assess the suitability of recently published reference anthropometric data for evaluation of the growth of children in our region., Setting: Referral Pediatric Endocrinology Clinic in tertiary level care hospital., Subjects: 280 normal school children and 155 children referred for growth retardation to the clinic in 1993 and 1994., Methods: Heights of school children were plotted on growth charts created from recently published reference growth data of children from high socioeconomic group families. The case records of 155 children referred for growth evaluation were retrospectively analyzed for (i) etiology of short stature, (ii) height percentile based on previously used Indian Council of Medical Research (ICMR) references, and (iii) height percentile and standard deviation scores based on the new references., Results: 93% of school children fell above and 7% below the 5th centile of the new height references. Of the 129 clinic children diagnosed to have growth retardation, 128 fell below the 5th centile of the new references. However, 38 of these (29.5%) fell above the 5th centile of ICMR references. These included patients with pathological causes of short stature. Twenty four of 26 children labelled as having no growth problem fell above the 5th centile of new reference data., Conclusions: The 5th height centile of new reference data from high socioeconomic group children is an appropriate cut off below which to evaluate children for short stature in our region. It will allow earlier identification and treatment than the hitherto used ICMR percentiles, and yet is not expected to result in over investigation of normal children.