Background
Why is the review needed?
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To determine the effectiveness of interventions across all outcomes conducted with children, young people and school personnel to optimize T1D care and management in educational settings,
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To explore the attitudes and experiences of children and young people with T1D and those involved with their care and management to identify the barriers and facilitators to achieving optimal T1D management educational settings, and
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To conduct an overarching synthesis to determine the extent to which interventions to optimize T1D care and management in educational settings addressed the barriers, and built on the facilitators, to optimal care identified by children, young people, parents and school personnel.
Conceptual framework
Assembling school health care plans
| |
Checking blood glucose during the school day
| |
To provide and clean and safe environment [11]. | |
Suitable location to check blood glucose [9]. | |
Accessibility and storage of supplies
| |
Provision of fridge space for spare supplies of insulin [11]. | |
Provide correct storage of supplies where necessary [11]. | |
Parents and, where appropriate, school nurses and other carers should have access to glucagon for subcutaneous or intramuscular use in an emergency, especially when there is a high risk of severe hypoglycaemia [17]. | |
Parents and, where appropriate, school nurses and other carers should be offered education on the administration of glucagon [17]. | |
The provision of emergency supply boxes [11]. | The parents/guardian must provide an emergency supply kit for use in the event of natural disasters or emergencies when students need to stay at school [20]. |
Hyperglycemia remedies should always be readily available at school [18]. | |
Administering insulin during the school day
| |
Provide and clean and safe environment [11]. | The school nurse and/or trained diabetes personnel should assist with insulin administration in accordance with the student’s health care plans and education plans [20]. |
Suitable, private location to manage injections [9]. | |
Accessibility of and participation in physical education in schools
| |
Schools should allow children and young people with diabetes to manage their diabetes according to their chosen management form and to take part in the full range of school activities [12]. | Students with diabetes should participate fully in physical education classes and team or individual sports [20]. |
Staff in charge of physical education or other physical activity sessions should be aware of the need for them to have glucose tablets or a sugary drink to hand [9]. | Physical education teachers and sports coaches must be able to recognize the symptoms of hypoglycemia and be prepared to call for help with a hypoglycemia emergency [20]. |
Food and dietary management
| |
To give permission for child/young person to eat whenever required [11]. | |
Children and young people with diabetes need to be allowed to eat regularly during the day. This may include eating snacks during class-time or prior to exercise. Schools may need to make special arrangements for them if the school has staggered lunchtimes [9]. | |
Snacks should be available during the school day [18]. | The food service manager or staff and/or the school nurse should provide the carb content of foods to the parents/guardian and the student [20]. |
Planning for special events, field trips, and extracurricular activities
| |
Pupils with diabetes must not be excluded from day or residential visits on the grounds of their condition [12]. | Full participation in all field trips, with coverage provided by trained diabetes personnel [19]. |
Information should be readily available from the paediatric diabetes specialist nurse on the inclusion of children and young people with diabetes on school trips [11]. | The school nurse or trained diabetes personnel should accompany the student with diabetes on field trips [20]. |
Parental attendance at field trips should never be a prerequisite for participation by students with diabetes [20]. | |
The school nurse or trained diabetes personnel should be available during school-sponsored extracurricular activities that take place outside of school hours [20]. | |
Flexible accommodation for exams and tests
| |
Alternative times and arrangements for academic exams if the student is experiencing hypoglycaemia or hyperglycaemia [20]. | |
Dealing with emotional and social issues
| |
The student’s personal diabetes health care team and school health team must be aware of emotional and behavioral issues and refer students with diabetes and their families for counseling and support as needed [20]. | |
Assisting the student with performing diabetes care tasks
(Blood glucose monitoring, insulin and glucagon administration, and urine or blood ketone testing)
| |
Assignment of diabetes care tasks, must take into account State laws that may be relevant in determining which tasks are performed by trained diabetes personnel [20]. | |
The school nurse is the most appropriate person in the school setting to provide care for a student with diabetes [20]. | |
Diabetes education and training of school nurses and school personnel
| |
Staff in schools should receive appropriate and consistent training, advice and support from health services and children’s diabetes specialist service [11]. | |
Education about diabetes must be provided to teachers and other school personnel, including school receptionists, PE teachers and school nurses, on a regular basis [12]. | School personnel who have responsibility for the student with diabetes throughout the school day (e.g., classroom, physical education, music, and art teachers and other personnel such as lunchroom staff, coaches, and bus drivers).- Level 2 Diabetes Basics and What to Do in an Emergency Situation [19, 20, 22]. |
Children and young people, their parents, schoolteachers and other carers should be offered education about the recognition and management of hypoglycaemia [17]. | |
Staff members need an appropriate level of diabetes education, and this should be relevant to activities that take place on the premises as well as those associated with participation in school trips and camps [24]. | |
It is important that when staff agree to administer blood glucose tests or insulin injections, they should be trained by an appropriate health professional [17]. | School nurses need to update their diabetes knowledge regularly and have their competencies checked on a regular basis [21]. |
Training of nonmedical school personnel to perform diabetes care duties is essential and should be facilitated by a diabetes-trained health care professional such as the school nurse or a certified diabetes educator [20]. | |
Recognizing and treating hypoglycemia
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Early recognition of hypoglycemia symptoms and prompt treatment [20]. | |
All school personnel who have responsibility for the student with diabetes should receive a copy of the Hypogycemia Emergency Care [20]. | |
Recognizing and treating hyperglycemia
| |
Hyperglycemia needs to be recognized and treated in accordance with the student’s DMMP [20]. | |
Communication between school health personnel and diabetes healthcare providers
| |
None identified | None identified |
Self-care and management at college/university
| |
None identified | None identified |
Methods
Review design
Search methods
Quantitative review of the strategies and/or interventions that are conducted within an educational setting that seek to improve the care of children and young people with type 1 diabetes | ||||
---|---|---|---|---|
Setting | Population | Intervention and issues of interest | Comparison | Evaluation |
Educational Setting in any country | Children/Young People with type 1 diabetes | All interventions to promote optimal management diabetes in school settings | Any comparison of interest including usual care | Blood Glucose Monitoring |
12th/twelfth grade | 3- 18 years pre school or education | Educational | Glyc*mic control | |
6th/sixth grade | 18 – 30 in higher education | Psychosocial | Blood Glucose Monitoring | |
College |
School-aged children
| Medical | Blood Glucose Levels | |
Diabetes Camp | P*diatric | Nursing | Self Monitoring Blood Glucose | |
Institute | Child$ | Psychotherapeutic | Blood glucose testing | |
Junior High | Adolescen$ | Secondary issues to include programme theory and service delivery. | BG | |
Kindergarden | Young person$ | Metabolic glyc*mic control | ||
Kindergarten | Young people | Glucose control | ||
Nursery | Young patients | SMBG | ||
Polytechnic | Young women | Self monitoring | ||
Pre School | Young men | Self regulation | ||
School | Young adult$ | Metabolic control | ||
School Camp | Youngsters | Blood sugars | ||
Summer camp | Youth | Hypos | ||
University | Year old$ | Hyperglyc*mia | ||
Teen$ | Low blood sugar | |||
Years of age | Hyperglyaemia | |||
Juvenile | High blood sugar | |||
Pube$ | ||||
Adult {and type 1 and/ , ages 16, 17, 18) | ||||
HbA1c | ||||
Condition
| Glycos*lated H*moglobin | |||
Diabetes | Glycated H*mogloblin | |||
Diabetes Mellitus | GHb | |||
Diabetes Mellitus , Type 1 | H*moglobin A1c | |||
Diabetic | HbA1c | |||
Diabetic patients | Auto controlling gly*emia | |||
Diabetic control | ||||
Type 1 or type l | Insulin Management | |||
DM | Insulin injections | |||
IDDM | Insulin sensitivity | |||
Insulin dependent diabetes mellitus | Insulin adjustment | |||
Sudden onset diabetes mellitus | Insulin replacement | |||
Auto immune diabetes mellitus | Hypoglycemic Agents | |||
Insulin deficient diabetes mellitus | ||||
Diabetes insipidus | Dietary behaviour | |||
Early diabetes mellitus | Nutrition | |||
Labile diabetes mellitus | Eating patterns | |||
T1D | Eating behavio*r | |||
Juvenile Diabetes | Carbohydrates | |||
Carbs | ||||
CHO | ||||
Snacks | ||||
Snacking | ||||
Carbohydrate Counting | ||||
Carb Counting | ||||
Qualitative synthesis of the facilitators and barriers to managing type 1 diabetes within an educational setting for children and young people with type 1 diabetes and those involved with their care | ||||
Setting
|
Perspective/People
|
Issues of Interest
|
Comparison
|
Evaluation
|
Educational Setting in any country | Children/Young People with type 1 diabetes | Facilitators/Barriers to: | Compare children with parents/professionals | Management |
12th/twelfth grade | 3 - 18 years preschool or formal education | Family | Patient care management | |
6th/sixth grade | 18 – 30 post compulsory education | Problems/Support | Families | Management skills |
College |
School-aged children
| Knowledge of | Siblings | Self-management behaviours |
Diabetes Camp | P*diatric | Attitudes to | Brothers | |
Institute | Child$ | Experiences of | Sisters | Self-management |
Junior High | Adolescen$ | Knowledge | Parents | Self-care |
Kindergarden | Young person$ | Attitudes | Mother | Care |
Kindergarten | Young people | Training of staff | Father | Self-efficacy |
Nursery | Young patients | Compliance | Grandparents | Self Regualt$ |
Polytechnic | Young women | Behaviours | Peers | Self monitor$ |
Pre School | Young men | Knowledge | School Nurses | Self manage$ |
School | Young adult$ | Attitudes | School Staff | Self Adheren$ |
School Camp | Youngsters | Training of staff | Teachers | Medical Management |
Summer camp | Youth | Compliance | School Psychologists | Health care routines |
University | Year old$ | Behaviours | School Counsellors | Health related quality life |
Teen$ | Needs | School Nurses | ||
Years of age | Perceptions | School Health Professionals | ||
Juvenile | Concerns | School personnel | ||
Pube$ | Practices | School Administrators | ||
Adult {and type 1 and/, ages 16, 17, 18) | Expectations | Coaches | ||
Teaching assistants | ||||
Learning support assistant/LSA | ||||
Condition
| ||||
Diabetes | ||||
Diabetes Mellitus | ||||
Diabetes Mellitus, Type 1 | ||||
Diabetic | ||||
Diabetic patients | ||||
Diabetic control | ||||
Type 1 or type l | ||||
DM | ||||
IDDM | ||||
Insulin dependent diabetes mellitus | ||||
Sudden onset diabetes mellitus | ||||
Auto immune diabetes mellitus | ||||
insulin deficient diabetes mellitus | ||||
Diabetes insipidus | ||||
Early diabetes mellitus | ||||
Labile diabetes mellitus | ||||
T1D | ||||
Juvenile Diabetes |
Inclusion/exclusion criteria
Screening
Search outcome
Quality assessment
Author/s Country | Randomisation | Blinding | Sample size | Comparability of groups at baseline | Length of follow up | ITT | Risk of Bias |
---|---|---|---|---|---|---|---|
Concealment | Use of power calculation | Attrition | |||||
Children and young people with T1D at school settings
| |||||||
Nguyen et al.[30] US | Unclear | Not applicable | 18 | Yes | 3 months | Not reported | Unclear |
Unclear | No | 2 dropped out of control group | |||||
Izquierdo et al.[31] US | Unclear | Not applicable | 41 | Apart from mean body mass index which was lower in the intervention group | 1 Year | Not reported | Unclear |
Unclear | No | Not reported | |||||
School personnel working with children and young people with T1D
| |||||||
Husband et al.[32] Canada | Unclear | Not applicable | 44 | Yes | 7 weeks | Not reported | Unclear |
Unclear | No | 37/44 completed (84%) |
Study/Country | Design | Participant details | Age (years) | Quality appraisal |
---|---|---|---|---|
Provider of intervention | ||||
Children and young people with T1D at school settings
| ||||
Izquierdo et al.[31] US | RCT – 2 arms | 25 schools with 41 children randomised | Target range: Kindergarten to 8th grade (≤13 years) | See Table 3
|
Intervention (n = 23) Usual care (n = 18) | Intervention: 9.74 ± 2.18 years | |||
School nurse/PDSN | Control 10.56 ± 2.5 years | |||
Engelke et al.[35] US | Before and after study | 36 children | Target range 5–19 years | ABCDEGHI |
School nurse | Actual age of sample not specified | |||
Nguyen et al.[30] US | RCT – 2 arms | 36 children | I: Range 11–16 years | See Table 3
|
I (n = 18)/C (n = 18) | Mean 14.0 + 1.8 years | |||
School nurse/Parents | C: Range 10–17 years | |||
Mean 13.3 + 1.7 | ||||
Faro et al.[36] US | Before and after study | 27 children | Target range: Kindergarten to 6th grade (≤11 years) | ABCEH |
PNP | Actual age of sample not specified | |||
Wdowik et al.[37] US | Controlled trial | 31 university students | Actual range: 18 to 27 years | ABCDEHI |
I (n = 21)/C (n = 10) | Mean 22 years | |||
RD/CED | ||||
School personnel working with children and young people with T1D
| ||||
Husband et al.[32] Canada | RCT – 2 arms | 44 elementary teachers | Sample characteristics of children with T1D not specified | See Table 3
|
I (n = 22)/C (n = 22) | ||||
Diabetes researchers | ||||
Siminerio and Koerbel [38] US | Before and after study | 156 school personnel from six school districts | Not linked to specific children with T1D | ABCEF |
Diabetes educators (n = 2) | ||||
Cunningham and Wodrich [39] US | Analog experiment (allocated) | 90 regular & SE elementary teachers from 4 schools | Not linked to specific children with T1D | ABCDEFI |
Researchers | ||||
Wodrich [40] US | Analog experiment (random assignment) | 122 CE & P-S teachers from 1 university | Not linked to specific children with T1D | ABCDEFI |
Researchers | ||||
Bullock et al.[41] US | Cohort study | 537 school nurses | Not linked to specific children with T1D | ABCDEFHI |
Participation in an on-line CEP for T1D (n = 120) | ||||
Who had not participated in CEP for T1D | ||||
(n = 417) | ||||
Researchers from MDHSS/MUSSON | ||||
Bachman and Hsueh [42] US | Program evaluation | 15 school nurses | Not linked to specific children with T1D | ABCDEFHI |
Participated in an on-line CEP for T1D | ||||
Researchers |
Study/Country | Design | Participant details | Age (years) | Quality appraisal |
---|---|---|---|---|
Children, young people and/or parents with T1D at school settings
| ||||
Nabors et al.[46] US | Interviews | 105 children whilst at day and summer camp | Mean 10.11 (S.D. 2.2) | ABCDEHI |
Survey | Range 6 – 14.6 | |||
Bodas et al.[47] Spain | Survey | 414 children whilst at summer camps | Target range 6-16 | ABCEFI |
Peters et al.[48] US | Survey | 167 children from diabetes’s clinic | Mean 12.8 (S.D. 2.5) | |
Review of clinic records | Target range 8-17 | ABCDEFGHI | ||
Lehmkuhl and Nabors [49] US | Survey | 58 children whilst at summer camp | Mean 11.5 (S.D 1.0) | ABCEHI |
Pilot Study | Target range 8-14 | |||
Tang and Ariyawansa [50] UK | Survey | 11 children & 11 parents from diabetes clinics | Target range 12-16 | ABCEFHI |
Wang et al.[51] Taiwan | Interviews | 2 children | Age 14/Age 15 | ABCDEFGHI |
Newbould et al.[52] UK | Interviews | 26 children & 26 parents from GP practices | Mean 11.7 | ABCDEFGHI |
Target range 8-15 | ||||
MacArthur [53] UK | Survey | 15 children from diabetes clinics | Target range 10-16 | ABCHI |
Clay et al.[54] US | Survey | 75 children & 75 parents from diabetes clinics | Mean 13.3 (S.D. 2.8) | ABCDEFGHI |
Target range 8-18 | ||||
Schwartz et al.[55] US | Survey | 80 children & 80 parents from diabetes clinics | Target range 5-12 | ABCEH |
Hema et al.[56] US | Self completion diaries | 52 children whilst at summer camp | Mean 13.02 (S.D. 2.66)/Target range 8-18 | ABCDEFHI |
8-12 (n = 19)/13–18 (n = 33) | ||||
Peyrot [57] Brazil, Denmark, Germany, Italy, Japan, The Netherlands, Spain, USA | Survey | 1905 childrena
|
aMean 21.3 (S.D. 2.4 )/Target range 18-25 | ABCDEFHI |
4099 parentsb part of DAWN Youth WebTalk study |
bMean 10.5 (S.D. 4.2)/Target range 0-16 | |||
Carroll and Marrero [58] US | Focus groups | 31 children from physicians’ offices | Mean 14.9 | ABCDEFGHI |
Target range 13-18 | ||||
13-14 (45%), 15–16 (35%), 17–18 (20%) | ||||
Waller et al.[59] UK | Focus Groups | 24 children & 29 parents from diabetes clinics | Mean 13.07 (S.D 1.59) | ABCDEFGHI |
Target range 11–16 | ||||
Hayes-Bohn et al.[60] US | Interviews | 30 children & 30 parents from diabetes clinics | Mean 17.3 | ABCDEFHI |
Target range 13-20 | ||||
Wagner et al.[61] US | Survey | 58 children & 58 parents Whilst at summer camp | Mean 12 (S.D 1.9) | ABCDEFHI |
Target range 8-15 | ||||
Amillategui et al.[62] Spain | Survey | 152 childrena
|
aMean 10.68 (S.D 1.92)/Target range 6-13 | ABCDEFHI |
167 parentsb from paediatric unit s of 9 hospitals | 6-9 (29%)/10–13 (71%) | |||
bMean 10.37 (S.D 2.15)/Target range 6-13 | ||||
6-9 (35%)/ 10–13 (65%) | ||||
Barnard et al.[63] UK | Interviews | 15 children & 17 parents registered on the Roche Diagnostics insulin pump user customer database | Mean age 12.07 (S.D. 2.71) | ABCDEFGHI |
Target Range 9-17 | ||||
Low et al.[64] US | Interviews | 18 children & 21 parents Whilst at diabetes camps & a regional paediatric endocrinology practice. | Mean age 13.9 (S.D. 2.2) | ABCDEFGHI |
Target range 11-18 | ||||
Wilson and Beskine [65] UK | Survey | 73 parents via a survey on the UK CWD website | <5 (11%), 5–11 (55%), >12(34%) | ABCDEH |
Amillategui et al.[66] Spain | Survey | 499 parents from diabetes clinics | Target range 3-18 | ABCDEFGHI |
3-6(12%), 7-10(26%), 11-14(38%), 15-18(24%) | ||||
Pinelli et al.[67] Italy | Survey | 220 parents from 15 diabetes units | Mean 10 | ABCDEFI |
Target range 8-13 | ||||
Hellems and Clarke [68] USA | Survey | 185 parents from diabetes clinics | Target range 5-18 | ABCDEGHI |
Jacquez et al.[69] US | Survey | 309 parents from diabetes clinics | Mean 11.83 (S.D. 3.70) | ABCDEFGI |
Target range 4-19 | ||||
Lewis et al.[70] US | Survey | 47 parents from diabetes clinics | ns | ABCEI |
Yu et al.[71] US | Survey | 66 parents from paediatric endocrinology unit | Mean 12.7 (diagnosed at ≤5 yrs)
| ABCDEFGI |
Mean 12.6 (diagnosed after 5 yrs)
| ||||
Lin et al.[72] Taiwan | Interviews | 12 mothers from diabetes clinics | Mean 8.4 | ABCDEFGHI |
Range 7.3 to 9.2 | ||||
Ramchandani et al.[73] US | Survey | 51 students (42 valid) from 5 hospital diabetes centres | Mean 20.1 (S.D. 1.6) | ABCDEFHI |
Range 18.4- 25.7 | ||||
Interviews | 17 students from 5 university health centres | Actual range 18-25 | ABCDEFGHI | |
Research diaries | ||||
Wdowik et al.[79] US | Survey | 98 students from 22 college health providers | Mean 24.4 (S.D. 7.4) | ABCDEFGHI |
Wdowik [80] US | Focus groupa
|
a10 students from 1 university health centre |
1Target range 18–35 (2 over 24 years) | ABCDEFHI |
Interviewsb
|
b15 students attended pre-college workshop at local diabetes centre representing 9 colleges across 7 states |
bTarget range 19-22 | ||
Geddes et al.[81] UK | Case notes | 55 students Referrals over a 10 year period to one hospital diabetes centre | Target range 18-24 | ABCDEFGH |
Ravert [82] US | Survey | 450 students T1D on graduate surveys | Mean 20.3 (S.D. 1.6) | ABCDEFI |
Target range 18-25 | ||||
Wilson [83] UK | Interviews | 23 students no details provided | Actual range 17-19 | ABCEFGHI |
17 (30%), 18 (44%), 19 (26%) | ||||
Miller-Hagan and Janas [84] US | Interviews | 15 students Advertisements placed in one university | Mean 22.4 | ABCDEFI |
Actual range 18-40 | ||||
Eaton et al.[85] UK | Interview | 22 students | Mean 20 | ABC |
From one university medical practice | Target range 19-21 | |||
Amillategui et al.[62] Spain | Survey | 111 teachers of children with T1D attending the paediatric units of nine public hospitals. | Experience of teaching a child with T1D (100%) | ABCDEFHI |
School personnel working with children and young people with T1D
| ||||
Greenhalgh [86] UK | Survey | 85 teachers of children with T1D who attended a diabetes clinic a local hospital 30 teachers | Experience of teaching a child with T1D (96%) | ABCDE |
Bowen [87] UK | Survey | School nurse assigned to 5 schools | Had taught a child with diabetes (20%) | ABCDEFGHI |
Not linked into specific children with T1D | ||||
Survey | 1140 teachers from 49 randomly selected schools | Not linked into specific children with T1D | ABCDEF [88] | |
ABCDEFI [89] | ||||
Gormanous et al.[90] US | Survey | 463 teachers from schools in one US state | Not linked into specific children with T1D | ABCDEHI |
Tahirovic [91] Bosnia and Herzegovina | Survey | 83 physical education teachers. All schools within the region included | Not linked into specific children with T1D | ABCDEFH |
MacArthur [53] UK | Survey | 11 teachers | Experience of teaching a child with T1D (100%) | ABCHI |
Linked with children from one local diabetes centre who took who took pre lunch injections at school | ||||
Boden et al.[92] UK | Interviews | 22 teachers | No experience (9%)/Currently teaching (46%) In directly involved (9%)/taught in previous year (27%) Taught a child though no longer in school (9%) | ABCDEFGHI |
25 primary schools with a child with diabetes in the school (currently or who had left very recently) | ||||
Nabors et al.[93] US | Survey | 247 teachers from 5 elementary schools in one city | Not linked into specific children with T1D | ABCEFGHI |
Lewis et al.[70] US | Survey | 65 teachers | Not linked into specific children with T1D | ABCEI |
222 schools in 3 counties were randomly selected to participate in the study. | ||||
Rickabaugh and Salterelli [94] US | Survey | 32 physical education teachers linked with 25 children with T1D from schools across three states. | Had taught on average 4 children with T1D | ABCDEGHI |
Chmiel-Perzynska et al.[95] Poland | Survey | 52 teachers Part of a wider survey | Currently teaching or had taught a child with diabetes. | ABCDE |
Not linked into specific children with T1D | ||||
Fisher [96] US | Survey | 70 school nurses from a convenience sample of 115 schools | Experience of children with T1D: 63% | ABCDEGHI |
Number of children with T1D: 0 (37%)/1 (31%)/2(21%)/3 (6%)/4(3%)/5(1%) | ||||
Guttu et al.[97] US | Survey | 21 counties, 19 provided school nurse services | Each county was characterised as having a good nurse-student ratio (1 nurse < 1,000 students) or a fair to poor nurse-student ratio (1 nurse >1,000 students | ABCDEI |
Joshi et al.[98] US | Survey | 43 school nurses from schools in 1 US state | Not provided | ABCEH |
Nabors et al.[99] US | Survey | 38 school nurses from schools in 3 US states | Experience of children with T1D: 87% Number of children with T1D: ns | ABCDEHI |
Wagner and James [100] US | Survey | 132 school counsellors attendees at two school counsellor association annual meetings | Experience of children with T1D: 83% children with diabetes in their schools. | ABCDEFGHI |
14% did not know if there were children with diabetes in their schools. | ||||
Number of children with diabetes average of 4 students | ||||
Schwartz et al.[55] US | Survey | 28 school personnel Linked with children from a hospital diabetes centre. 20 schools represented | Experience of children with T1D: 63% Number of children with diabetes: | ABCEH |
School nurses (85%); | 0(5.9%) / 1–2 (27.5%) | |||
Dieticians, teachers, & other (15%) | 3–4 (41.2%) / 5–10 (13.7%) | |||
>10 (11.8%) | ||||
Darby [101] US | Interviews | 11 school nurses helped students with CSII therapy | Experience of children with T1D: 100% | ABCDEFHI |
Survey of local schools across 3 counties | Number of children with T1D: 1-4 | |||
RN(n = 6), CNP or APN: (n = 2)/LPN (n = 3) |