Objective: To evaluate the clinico-epidemiological and metabolic profile of children aged 6 months to 18 years with Type 1 Diabetes Mellitus (T1DM).

Methods: This observational study was conducted over one year at a tertiary care center in Shimla, Himachal Pradesh. A total of 45 children diagnosed with T1DM according to ISPAD guidelines were enrolled. Baseline clinical characteristics, metabolic parameters, autoantibody profiles, and a 3-month follow-up for glycemic control (HbA1c) were evaluated.

Results: Out of 45 children (mean age 9.64 ± 4.01 years; male to female ratio 1.04:1), 71.11% resided in rural areas and 68.89% were newly diagnosed cases. The most frequent clinical presentation was diabetic ketoacidosis (DKA) in 35.56% of patients, primarily among those newly diagnosed. Baseline glycemic control was poor, characterized by a mean HbA1c of 12.06 ± 2.79%, with 77.8% categorized as having poor control (>10%). At the 3-month follow-up, the mean HbA1c improved to 10.48 ± 2.35%, although 55.56% of the children remained in the poor control category. The mean insulin requirement was 1.08 ± 0.30 IU/kg/day. GAD-65 autoantibodies were positive in 17.78% of the cohort.

Conclusion: Pediatric T1DM in this region frequently presents with DKA at disease onset. While short-term insulin management improves overall HbA1c, suboptimal glycemic control remains highly prevalent, emphasizing the critical need for enhanced early detection and targeted interventions to improve long-term adherence.

KEYWORDS: Diabetes Mellitus, Type 1, Diabetic Ketoacidosis, Glycated Hemoglobin A, Child, Epidemiology.