Type 1 diabetes occurs more frequently in younger children who are often pre-school age and enter the education system with diabetes-related support needs that evolve over time. It is important that children are supported to optimally manage their diet, exercise, blood glucose monitoring and insulin regime at school. Young people self-manage at college/university. Theory-informed mixed-method systematic review to determine intervention effectiveness and synthesise child/parent/professional views of barriers and facilitators to achieving optimal diabetes self-care and management for children and young people age 3–25 years in educational settings. Eleven intervention and 55 views studies were included. Meta-analysis was not possible. Study foci broadly matched school diabetes guidance. Intervention studies were limited to specific contexts with mostly high risk of bias. Views studies were mostly moderate quality with common transferrable findings. Health plans, and school nurse support (various types) were effective. Telemedicine in school was effective for individual case management. Most educational interventions to increase knowledge and confidence of children or school staff had significant short-term effects but longer follow-up is required. Children, parents and staff said they struggled with many common structural, organisational, educational and attitudinal school barriers. Aspects of school guidance had not been generally implemented (e.g. individual health plans). Children recognized and appreciated school staff who were trained and confident in supporting diabetes management. Research with college/university students was lacking. Campus-based college/university student support significantly improved knowledge, attitudes and diabetes self-care. Self-management was easier for students who juggled diabetes-management with student lifestyle, such as adopting strategies to manage alcohol consumption. This novel mixed-method systematic review is the first to integrate intervention effectiveness with views of children/parents/professionals mapped against school diabetes guidelines. Diabetes management could be generally improved by fully implementing and auditing guideline impact. Evidence is limited by quality and there are gaps in knowledge of what works. Telemedicine between healthcare providers and schools, and school nurse support for children is effective in specific contexts, but not all education systems employ onsite nurses. More innovative and sustainable solutions and robust evaluations are required. Comprehensive lifestyle approaches for college/university students warrant further development and evaluation.

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An ongoing struggle: a mixed-method systematic review of interventions, barriers and facilitators to achieving optimal self-care by children and young people with Type 1 Diabetes in educational settings

More than 160,000 children and adolescents with type 1 diabetes are enrolled in public and private schools in the United States.1,2 School children with type 1 diabetes must be afforded the proper time and tools for diabetes self-care to be safe, learn effectively, and be able to participate in all school activities.3,4 In addition, knowledgeable school personnel are needed to assist them when they do need help.

Thanks to the efforts of the American Diabetes Association (ADA), the Juvenile Diabetes Research Foundation (JDRF), the National Diabetes Education Program (NDEP), and the Children with Diabetes Web site, much progress has been made in the past 20 years to ensure that children in schools are safe and protected. Each of these organizations has provided valuable educational and advocacy resources for parents and educational materials for school systems.

The daily self-management of children and adolescents with type 1 diabetes is complex and dynamic. It requires frequent self-monitoring of blood glucose (SMBG), insulin injections, and individual meal plans.5-7 However, changes in daily schedules (e.g., recess, physical education class, school outings, and participation in sports) or an acute illness complicate children's blood glucose management while at school. In addition, children are continually growing during each academic year, requiring frequent changes to their individualized treatment plans. Decisions concerning adjustments in insulin doses occur often while children are in school and frequently must be made by a school nurse, parent, or guardian following protocols in the comprehensive diabetes care plan prescribed by the children's physicians.8,9

School nurses are the principal contact person between parents and guardians and health care providers with regard to updating children's individualized diabetes care plans for management of acute problems during the school day. Unfortunately, some school systems do not have …

https://spectrum.diabetesjournals.org/content/diaspect/23/1/47.full.pdf

Experiences of Children and Adolescents With Type 1 Diabetes in School: Survey of Children, Parents, and Schools

Type 1 diabetes is one of the most common chronic childhood diseases, while type 2 diabetes in children is increasing at alarming rates globally. Against this backdrop, the school is a critical environment for children with diabetes. They continue to face barriers to education that may lead to depression, poor academic performance, and poor quality of life. To address these challenges, diabetes interventions have been implemented in school and the goal was to systematically review these interventions and their outcomes between 2000 and 2013. Fifteen studies were included in the narrative synthesis. Education of school personnel was the main focus before 2006. Studies reported gains in knowledge and perceived confidence of school staff. Since 2006, more comprehensive interventions have been developed to promote better care coordination and create a safe school environment. These studies reported improved diabetes management and quality of life of students. Assessment tools varied and study design included randomized controlled trials, quantitative and qualitative methods. Although many of the studies reported a significant difference in the parameters measured, it was not possible to determine optimal ways to improve the health, quality of life and academic performance of children with diabetes, given the disparity in scope, assessment tools and measured outcomes. Experimental designs, longer follow-up studies, larger sample sizes, and a higher number of participating schools are critical issues to consider in future studies. Most of the research was conducted in North America and further research is needed in other parts of the world. Significance for public healthDiabetes is one of the most common chronic childhood diseases; both type 1 and type 2 diabetes are increasing in children globally. Against this backdrop, the school is a critical environment for children with diabetes. This systematic literature review on school-based diabetes interventions and their outcomes demonstrates that increasing efforts are being made to improve diabetes care and create a safe school environment. Studies reported gains in knowledge and confidence of school staff, as well as improved health and quality of life of students. Given the disparity of the assessment tools used, it was not possible to determine optimal ways to improve the health, quality of life and academic performance of children with diabetes. Future evaluations should include experimental designs, longer follow-up studies, and larger sample sizes. School-based diabetes interventions and solid evaluations will contribute to improving diabetes school policies and ensuring children with diabetes have the same educational opportunities as other children.

School-based diabetes interventions and their outcomes: a systematic literature review

Teachers are supporting an increasing number of pupils with long-term health conditions in mainstream schools. The aim of this literature review was to critically appraise and synthesise research that has examined teachers' perceptions of the key barriers and facilitators to supporting pupils with long-term conditions, teachers' training needs and interventions that aim to improve teachers' knowledge of long-term conditions, and teachers' confidence in supporting children and young people. A narrative literature review was conducted using a systematic search of computerised databases and manual searches of key journals and reference lists to retrieve studies published between 2003 and 2013. Studies were critically appraised and key themes across studies identified. In total, 61 papers from 58 studies were included in the review. The findings suggest that teachers receive little formal training relevant to long-term condition management and are fearful of the risks involved in teaching children and young people with long-term conditions. Communication between families, school and health and social care services appears to be poor. Educational programmes developed in conjunction with and/or delivered by healthcare professionals seem to have the potential to increase teachers' knowledge and confidence. This review suggests that healthcare professionals have an important role to play in supporting teachers in identifying and meeting the needs of pupils with long-term conditions. It is vital that pupils with long-term conditions receive appropriate care and support in schools to ensure their safety and help them to integrate with their peers and achieve their academic potential. Limitations in the current evidence are highlighted and implications for future research are identified.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/hsc.12104

Teachers' perspectives of supporting pupils with long‐term health conditions in mainstream schools: a narrative review of the literature

BACKGROUND
Diabetes mellitus (diabetes) is one of the most common metabolic diseases in children worldwide and the incidence of type 1 diabetes (T1D) is growing. T1D is complicated to manage and adolescents with diabetes face unique, age-specific challenges. The purpose of this article is to discuss ways in which schools can create a positive environment and improve the experiences and outcomes for adolescents with T1D.

METHODS
The Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed databases were searched and yielded a total of 27 articles that were used in this integrative literature review.

RESULTS
Common concerns identified by students with T1D and their parents included a lack of full-time school nurses, lack of teacher knowledge of diabetes, lack of access to diabetes tools, lack of freedom to perform diabetes self-care, lack of nutritional information in cafeterias, and lack of communication between parents and school personnel. Students who are unable to attend school on a daily basis may not be able to achieve their academic potential.

CONCLUSIONS
Implications for school health including specifics for school nurses, teachers, students, and school environment were identified.

Improving School Experiences for Adolescents with Type 1 Diabetes.

This integrative literature review examines research studies that describe the care of the student with type 1 diabetes at school and interventions to improve care. Participants of the studies include school nurses, counselors, staff, administrators, parents, and students with diabetes. The studies reviewed use a descriptive approach in examining care delivered with one study adding a qualitative approach for validation of results. The findings identified needed improvement in the following areas: communication, after-school support, education of staff and peers, school nurse availability, and lunch choices. The school nurse must advocate for the student with type 1 diabetes in each area of concern, especially in ensuring education of school staff who often provide care to these students.

Rebecca Tolbert

Papers

Managing type 1 diabetes at school: an integrative review.