Diminished school‐based support for the management of type 1 diabetes in adolescents compared to younger children

Abstract

Aims To evaluate diabetes management at school in a large cohort of adolescents with type 1 diabetes and to compare the level of support provided to adolescents with that provided to younger children.Methods Questionnaires were distributed to adolescents with type 1 diabetes attending nine regional and tertiary paediatric diabetes services in the Republic of Ireland. The data collected included patient demographics, treatment regimen and support provided for self-care management. Results were compared with a similar cohort of primary school children with type 1 diabetes, studied using similar methodology. ResultsThe study cohort comprised 405 adolescents with a median age of 15 years, of whom 215 (54%) were on multiple daily injections and 128 (32%) were on pump therapy. Eighty-five percent of pump users administered their bolus insulin in classrooms, whereas 76% of those on a multiple daily injection regimen injected outside the classroom. Girls were less likely to administer bolus insulin in an office (10% vs 19%) and more likely to administer it in the bathroom (50% vs 34%; P=0.01). Twenty-five adolescents (12%) on multiple daily injection regimens did not administer bolus insulin at school. Compared to primary school children with type 1 diabetes, adolescents were less likely to use pump therapy, have an emergency treatment plan and have a designated staff member responsible for care needs.Conclusions Support provided to adolescents with type 1 diabetes is diminished compared with that provided to younger schoolchildren.

Deterioration in glycemic control on schooldays among children and adolescents with type 1 diabetes: A continuous glucose monitoring-based study

“…In addition, another possible explanation is that girls are more likely to experience reduced insulin doses during schooldays than boys ( 38 ). One study showed a gender disparity regarding the location of insulin administration at school, with girls being significantly less likely to inject insulin in the classroom and more likely to inject in the bathroom ( 39 ). This difference in injection site increased the chances of girls missing insulin doses due to classes.…”

Diabetes representations on adherence and quality of life: Do parents and adolescents differ?

“…The development of autonomy from parents and the increase in responsibility in diabetes tasks may explain the decline in family participation and support in these tasks and the high dissimilarities in diabetes control, because parents and adolescents are no longer sharing the diabetes experiences (Hanna et al, 2012). Adolescents showed more responsibility in their diabetes management process compared with what their mothers reported, probably owing to the amount of time that adolescents spend outside the family, in school, and with their friends, which translates into a decrease in family supervision and a limited awareness of mothers regarding adolescents' diabetes performance (Marshall et al, 2018; McCollum & O'Grady, 2020). Also, adolescents' high representations of personal control and responsibility for diabetes tasks may be appropriate to reinforce adolescents' independence and responsibility (Hanna et al, 2012), which may improve QoL (Marshall et al, 2018).…”

ISPAD Clinical Practice Consensus Guidelines 2022: Management and support of children and adolescents with diabetes in school

“…Regardless of the student's level of responsibility, parents should remain involved and engaged as part of the school and health care teams. Adolescents are less likely than primary (elementary) students to have a designated staff member and emergency treatment plan, to use pump therapy, and more likely to miss boluses at school 42,47 . Even students who are independent may need help with diabetes management when they are sick or experiencing hypoglycemia.…”