ISPAD Clinical Practice Consensus Guidelines 2018: Management and support of children and adolescents with type 1 diabetes in school

Bratina, Nataša; Forsander, Gun; Annan, Francesca; Wysocki, Tim; Pierce, Jessica; Calliari, Luís Eduardo; Pacaud, Danièle; Adolfsson, Peter; Dovč, Klemen; Middlehurst, Angie; Goss, Peter W; Goss, J. L.; Janson, Staffan; Acerini, Carlo L.

doi:10.1111/pedi.12743

Cited by 65 publications

(76 citation statements)

References 84 publications

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“…Comparison of our results with previously published results from a Irish primary school cohort indicates that less support is provided to adolescents with type 1 diabetes in school than to their younger counterparts. This finding is contrary to the recent ISPAD clinical practice consensus guidelines, which state that, irrespective of age and ability, all students with type 1 diabetes should receive the support, encouragement and supervision of school personnel .…”

Section: Discussioncontrasting

confidence: 94%

“…This does not, however, guarantee the optimum environment for consistent delivery of adolescents’ care needs. Reasonable adjustments, as outlined by ISPAD , include school personnel support with insulin administration. In the Republic of Ireland, responsibility to ensure delivery of medical needs to any school‐going child or adolescent rests with their parents, in contrast to other countries, such as Sweden, where responsibility is transferred to the school .…”

Section: Discussionmentioning

confidence: 99%

“…This forms part of routine care for the school‐going child or adolescent and is ultimately the responsibility of each individual diabetes centre. ISPAD consensus guidelines recommend that all school‐going children and adolescents with type 1 diabetes should have one . In the 2008 study by Särnblad et al .…”

Section: Discussionmentioning

confidence: 99%

“…The identified challenges of supporting diabetes self‐care management in the school setting have resulted in the recent publication of consensus recommendations from the International Society for Paediatric and Adolescent Diabetes (ISPAD) . These issues are illustrated in the DAWN study, an international web survey with over 6000 participants with type 1 diabetes from eight countries, where respondents rated the level of support provided by schools as significantly lower than received elsewhere.…”

Section: Introductionmentioning

confidence: 99%

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

McCollum

O’Grady

2019

Diabet. Med.

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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.

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Section: Discussioncontrasting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

McCollum

O’Grady

2019

Diabet. Med.

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“…One of these provides recommendations on the use of technology in children, adolescents, and young adults with diabetes and appraises the pros and cons, as well as costs, of pumps, sensors, and automated insulin dosing devices . The other two new sections are guidelines for the management of diabetes care in preschool children and for children while attending school . These chapters consider several aspects necessary for successful treatment of children and adolescents, including education, nutrition, glucose monitoring, medication, and insulin or other therapy.…”

Section: Level Of Evidence Descriptionmentioning

confidence: 99%

ISPAD Clinical Practice Consensus Guidelines 2018: What is new in diabetes care?

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Educational Outcomes in Children and Adolescents With Type 1 Diabetes and Psychiatric Disorders

et al. 2023

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ImportanceResearch shows that children and adolescents with type 1 diabetes (T1D), compared with their peers without diabetes, have a greater risk of psychiatric disorders. However, no study has comprehensively examined whether having psychiatric disorders is associated with educational outcomes in children and adolescents with T1D.ObjectiveTo investigate educational outcomes in children and adolescents with T1D with and without psychiatric disorders.Design, Setting, and ParticipantsThis cohort study used data from multiple Swedish registers. The main study cohort included individuals born in Sweden between January 1, 1973, and December 31, 1997, who were followed up from birth through December 31, 2013. Data analyses were conducted from March 1 to June 30, 2022.ExposuresType 1 diabetes and psychiatric disorders (including neurodevelopmental disorders, depression, anxiety disorders, eating disorders, bipolar disorder, psychotic disorder, and substance misuse) diagnosed before 16 years of age.Main Outcomes and MeasuresAchieving educational milestones (completing compulsory school [primary and lower secondary education], being eligible to and finishing upper secondary school, and starting and finishing university) and compulsory school performances.ResultsOf 2 454 862 individuals (51.3% male), 13 294 (0.5%; 53.9% male) were diagnosed with T1D (median [IQR] age at diagnosis, 9.5 [6.0-12.5] years), among whom 1012 (7.6%) also had at least 1 psychiatric disorder. Compared with healthy individuals (without T1D and psychiatric disorders), individuals with T1D alone had slightly lower odds of achieving the examined educational milestones. However, those with both T1D and any psychiatric disorder had much lower odds of achieving milestones, including completing compulsory school (odds ratio [OR], 0.17; 95% CI, 0.13-0.21), being eligible for (OR, 0.25; 95% CI, 0.21-0.30) and finishing (OR, 0.19; 95% CI, 0.14-0.26) upper secondary school, and starting (OR, 0.36; 95% CI, 0.29-0.46) and finishing (OR, 0.30; 95% CI, 0.20-0.47) university. They also showed lower grade point averages for compulsory school subjects. These findings remained similar in sibling comparison analyses, suggesting independence from familial confounding.Conclusions and RelevanceIn this cohort study of Swedish-born children and adolescents, those with T1D alone had minor difficulties with their educational outcomes, whereas those with both T1D and psychiatric disorders had universal long-term educational underachievement. These findings highlight the importance of identifying psychiatric disorders in pediatric patients with T1D and the need for targeted educational intervention and support to minimize the education gap between the affected children and their peers.

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ISPAD Clinical Practice Consensus Guidelines 2018: Management and support of children and adolescents with type 1 diabetes in school

Cited by 65 publications

References 84 publications

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

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

ISPAD Clinical Practice Consensus Guidelines 2018: What is new in diabetes care?

Educational Outcomes in Children and Adolescents With Type 1 Diabetes and Psychiatric Disorders

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