Crystal C. Jackson

Care of Young Children With Diabetes in the Child Care Setting: A Position Statement of the American Diabetes Association

Diabetes is a relatively common chronic disease of childhood (1); however, capturing prevalence data in children with type 1 and type 2 diabetes has been challenging. The comprehensive SEARCH for Diabetes in Youth (SEARCH) study has made significant strides in better understanding disease prevalence in the pediatric population. A recent SEARCH study found that 1.93 per 1,000 youth (aged <20 years) were diagnosed with type 1 diabetes (2), an increase of 21.1% from 2001 to 2009, with increases seen in all ethnic groups but with non-Hispanic whites disproportionately affected (3). For type 2 diabetes, the SEARCH study reported a prevalence of 0.46 per 1,000 youth (aged 10–20 years), an increase of 30.5% from 2001 to 2009 in all ethnicities (3). As youth rarely die of diabetes, the increase in prevalence is most likely attributed to increased incidence. An annual increase of 2.3% in type 1 diabetes incidence has been reported in children, with children aged <5 years experiencing the greatest increase relative to all children (4). As type 2 diabetes is rarely seen in children younger than 10 years of age (3), this Position Statement will primarily focus on type 1 diabetes. The primary objective of this Position Statement is to explain that young children (aged ≤5 years) are a vulnerable population and have unique diabetes management needs. Our goal is to describe the diabetes management recommendations in the child care setting. The child care setting includes day care, camp, and other programs where young children with diabetes are enrolled. This Position Statement is meant to guide child care providers in caring for young children with diabetes and is not intended to provide specific advice on the medical management for this population. While Position Statements contain evidence-based recommendations, all of the information that pertains to young children is expert opinion …

Diabetes Care in the School Setting: A Position Statement of the American Diabetes Association

Diabetes is one of the most common chronic diseases of childhood (1). There are approximately 200,000 individuals <20 years of age with diabetes in the U.S. (2). The SEARCH for Diabetes in Youth (SEARCH) study recently reported that 1.93 per 1,000 (aged <20 years) were diagnosed with type 1 diabetes, an increase of 21% from 2001 to 2009. Increases in the prevalence of type 1 diabetes were seen in all ethnic groups, but non-Hispanic whites were disproportionately affected. Because type 2 diabetes rarely occurs in younger children, its prevalence in the population aged <20 years is not readily available. For type 2 diabetes in youth between 10 and 20 years of age, the SEARCH study reported a prevalence of 0.46 per 1,000 youth of all ethnicities, an increase of 31% from 2001 to 2009 (3). These statistics demonstrate the rising prevalence of diabetes in children and the increased need for diabetes management. The majority of young people with diabetes spend many hours at school and/or in some type of child care program. Trained and knowledgeable staff are essential to provide a safe school and child care environment for children with diabetes. This includes the provision of care during the school day, field trips, and all school-sponsored activities in the school setting and in preschool, day care, and camp programs in the child care setting. Staff play a critical role in helping to reduce the risk of short- and long-term complications of diabetes and ensuring that children are well-positioned for academic success and normal growth and development. The child’s parents/guardians and health care provider(s) should work together to provide school systems and child care providers with the information necessary to enable children with diabetes to participate fully and safely in the school and child care setting experiences (4–6). …

Providing a Safe Environment for Students with Diabetes

Abstract Current diabetes regimens require more effort than ever before. The level of diabetes control students are able to maintain is affected greatly by their ability to care for their diabetes during the school day. This article reviews use of School Health Plans and Diabetes Medical Management Plans in schools. Students with diabetes, their families, health care providers and school personnel all have responsibilities that should be outlined in these plans. School nurses coordinate school-based diabetes care, provide training to school staff members, advocate for students and monitor implementation of students’ school plans. Normal growth and development, prevention of complications and full participation in academic and social opportunities should be possible for students with diabetes. A variety of resources that support students with diabetes are described and referenced.

Health Care Plans to Manage Diabetes at School

The DMMP, prepared and signed by the student’s personal diabetes health care provider(s), contains tailored medical orders for each student. The DMMP is the basis for all of the health care and education plans designed to help the student manage diabetes effectively at school. The DMMP should be in place to ensure that the student’s diabetes health care needs are safely and appropriately met at school. The school nurse uses the DMMP to develop the other health care plans used at school for the student with diabetes: the student’s Individualized Health Care Plan and other education plans (e.g., a Section 504 Plan or Individualized Education Program [IEP]). Although the DMMP is not required by Section 504 of the Rehabilitation Act of 1973 (504), the Americans With Disabilities Act, or the Individuals With Disabilities Education Act, for the student with diabetes who is eligible for these additional educational plans, the medical orders contained in the DMMP should be incorporated into these additional educational plans. Information in the DMMP may include:

Supporting the Student’s Graduated Independence in Diabetes Care

The gradual progression to self-management is a critical milestone for children/adolescents with diabetes. This article provides recommendations to facilitate collaboration between the student’s family, diabetes healthcare provider, and school nurse to support and implement a plan that enables the child/adolescent to acquire the skills and knowledge necessary to successfully transition to independent management of diabetes.