When the Central Board of Secondary Education (CBSE) recently premitted students with Type 1 diabetes to carry glucometers and insulin pumps inside exam halls — it brought the often-overlooked topic of paediatric diabetes to the forefront.
For many families, this move came as a relief. Managing Type 1 diabetes is a round-the-clock task, and exam days, already stressful for most students, become even more complex for children who require constant glucose monitoring and insulin dosing. A Bengaluru-based mother welcomes this initiative, however, she also recalls how her daughter, a five-year-old living with Type 1 diabetes was barred from a school trip, despite her volunteering to accompany and take full responsibility. “This denial from lack of understanding is heartbreaking,” she says.
While the CBSE’s decision has sparked hope for greater support for children with Type 1 diabetes, there are still concerns over accomodating diabetes care throughout schoolife — access and implementation. Experts emphasise the need to understand existing advancements in treatment as well as challenges in paediatric diabetes care in India to comprehensively address existing gaps.
Understanding Type 1 diabetes in children
Shreevidya V., medical director of preventive health services, Apollo Hospitals, explains that it is important to be aware of and understand that two types of diabetes can affect children – Type 1 and Type 2 .
Type 1 diabetes is an autoimmune condition in which the body destroys insulin-producing beta cells in the pancreas. This makes insulin therapy a lifelong requirement. Type 2 diabetes, or diabetes mellitus on the other hand, is brought on, generally due to lifestyle issues, resulting in high blood sugar levels that are not controlled due to insufficient production of insulin. Type 1 diabetes is far more common than Type 2 in children. While there is currently no definitive way to prevent type 1 diabetes, research is ongoing to identify strategies to delay or prevent its onset, including early detection and potential interventions to preserve beta cells.
“Children living with Type 1 diabetes typically follow a basal-bolus insulin regimen, also known as multiple daily injections (MDI), that help mimic the body’s natural insulin production by using long-acting (basal) insulin to cover background needs and rapid-acting (bolus) insulin to cover mealtime needs,” says Suma Uday, senior consultant, paediatric diabetes, endocrinology and metabolic bone disease, Narayana Health, Bengaluru. She explains that the regimen includes three short-acting insulin shots before meals and one long-acting dose daily, and advanced options now include ultra-long-acting insulins that last up to 48 hours and ultra-short-acting versions that align better with meal timings.
COVID-19, in particular, is believed to have triggered autoimmune responses in some children, triggered the onset of Type 1 diabetes.
India’s growing paediatric diabetes burden
Tejasvi Sheshadri, paediatrician and paediatric endocrinologist, paediatric diabetes specialist, Rainbow Children’s Hospital Hebbal, Bengaluru, points out that India has the highest number of children and adolescents under 20 living with Type 1 diabetes globally – over 301,000. The country is second only to the U.S. in the total number of Type 1 diabetes patients, at approximately 9,41,000.
Despite this, access to consistent, affordable care remains unequal. While some states like Kerala, Tamil Nadu, and Gujarat provide free insulin and glucometers for children below the poverty line, many others including Karnataka fall short. In government hospitals across such States, even paediatric insulin may not be readily available.
Lynn Wilfred, primary care physician, CSI hospital, Chikkaballapura, Karnataka, emphasises that the challenges vary between urban and rural settings. Diagnosis is often under ₹600 in Tier 1 cities. However, treatment costs vary widely depending on where and how a child is treated.
In rural areas, the problem is also compounded by lack of awareness, limited access to screening, and socio-economic barriers. “Parents may not recognise early warning signs like blurred vision or darkening skin around the neck (a symptom called acanthosis nigricans),” says Dr. Wilfred. In such regions, community health workers and NGOs play a crucial role in raising awareness and conducting screenings.
He also explains about challenges due to lack of structured care, he says , “The biggest hurdle for Type 1 diabetes patients transitioning from rural to urban areas is the disparity in affordability and access to consistent care, with varying treatment modalities and medication availability.
The role of technology in diabetes management
Dr. Sheshadri explains how technology has revolutionised diabetes care for children, while she also expresses her concern over the affordability and access to these advancements. Continuous Glucose Monitors (CGMs) provide real-time readings and help detect spikes or drops in blood sugar. Devices like the Medtronic 780G hybrid closed-loop insulin pump offer precise insulin delivery with less manual intervention, and smart insulin pens digitally track doses. However, these tools are prohibitively expensive for many Indian families.
Additionally, she says, “While telemedicine and cloud-synced CGMs have allowed doctors to monitor patients remotely, especially helpful during and after the pandemic, this digital advantage remains accessible only to a privileged few.”
Looking ahead: what schools can do
The Indian Council of Medical Research (ICMR) and the Ministry of Health and Family Welfare have developed public health guidelines to improve early detection. Their focus is on identifying high-risk children — those with a family history of diabetes, obesity, or cardiovascular issues and conducting periodic glucose and BMI testing.
The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) also supports awareness camps and physical activity promotion in schools.
Dr. Uday explains, beyond exam-day accommodations, schools must adopt broader inclusive policies. Teachers and staff should be trained to identify symptoms of hypoglycemia and respond swiftly to emergencies. Flexible schedules around meals and sports, subsidised access to CGMs, and awareness campaigns could drastically improve the quality of life for children with diabetes.
“Early intervention is key. Globally, other countries have mandated pre-symptomatic screening in schools,” she says, citing the the European EDENT1FI initiative (European action for the Diagnosis of Early Non-clinical Type 1 diabetes For disease Interception — a project aimed at improving the early detection and management of type 1 diabetes (T1D) in children and adolescents through a pan-European screening program) that has proven that early diagnosis can reduce severe complications. “India could adapt similar models through pilot programmes and public health drives,” says Dr. Uday.
Experts say that the growing number of children diagnosed with diabetes, often underreported is a public health priority that needs school, community, and policy-level action — now more than ever.
Published – April 08, 2025 06:36 pm IST