Lack of trained staff, equipement and policies complicates diabetes management for children…
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Children spend up to 10 hours a day in the school system and with childhood obesity and physical inactivity on the rise, attention should be focused on this critical environment. Guidelines and organizations state that children with diabetes have the right to manage their diabetes without facing discrimination at school. However, there are a number of barriers that affect effective management and overall education. These obstacles include a lack of trained/educated staff, misconceptions, lack of equipment and a lack of policies for diabetes management. Children also have a limited ability to monitor their blood glucose and may be kept from engaging in extracurricular activities which may lead to poor academic performance and even depression.
A systematic review by researchers at the University of Lugano, Switzerland looked at 15 school-based diabetes interventions from 2000-2013 and analyzed their outcomes. The primary goal was to determine whether or not these interventions improved health, quality of life and academics in children with diabetes. All studies took place in North America, most lasted one year and the majority focused on type 1 with four studies focusing on both type 1 and type 2.
The results showed nine studies with statistically significant improvements. Significant improvement of diabetes knowledge in personnel following diabetes education programs were either face-to-face or computer-based (P<0.033 - P<0.001, depending on the study). In the two studies focusing on the children with diabetes there was a significant improvement in quality of life resulting from school-based case management interventions. There was a significant decrease in HbA1c in children whose type 1 was poorly controlled by school nurse-supervised glucose checks and insulin administration (P<0.0001). Perceived positive outcomes by parents and all authors who conducted satisfaction surveys reported high satisfaction rates with the interventions. Although the studies resulted in statistically significant improvements, it was not possible to determine the best ways to improve health, quality of life and academics in children with diabetes. Practice Pearls:
- Diabetes management needs to incorporate the school system in order to find the best approach to optimize health outcomes in children with diabetes.
- School-based diabetes interventions to improve personnel knowledge and training can lead to better outcomes in the health and quality of life for children with diabetes.
- There is not a standardized or optimal approach at this time to guide future school-based diabetes interventions.
Pansier, Bénédicte. “School-Based Diabetes Interventions and Their Outcomes: A Systematic Literature Review.” Journal of Public Health Research 4.1 (2015): 467. PMC. Web. 10 May 2015.