Stigmas, structure are the biggest school days challenges of diabetes management

Stigmas, structure are the biggest school days challenges of diabetes management | Image Credit: © Ana - © Ana - stock.adobe.com.

The challenges of managing diabetes in children is often viewed under the lens of maintain glycemic control and adhering to prescribed interventions. A new report, however, examined the challenges of diabetes management during the school years from the perspective of the daily social and institutional challenges children face.

The study, published in SSM: Qualitative Research in Health, relays the experiences of 19 children with diabetes and their experience in managing their condition in the school setting.

Using monitoring devices and adhering to treatment strategies may be perceived as the biggest challenges for young children during the school day, but the study highlights the fact that negative responses and a stigma from other students—as well as teachers and administrators—can be bigger challenges.

Schools that receive public funds must have personal trained in diabetes care and develop a plan to help each student manage their condition, according to the report. How this requirement is met in different states and school districts varies, though. Some states only require that schools receive written orders and parent consent regarding diabetes management, but not that a school nurse is present to deliver or oversee care.

The study authors found that a lack of school personnel, clear oversight by medical personnel, communication, and an overall understanding of diabetes complicated diabetes management for children during the school day.

Increased tools and technology for diabetes management can help student manage diabetes throughout the school day and give parents and healthcare teams better information from school hours. However, institutional models of schools don’t always complement the use of these tools.

Diabetes management improved while students were quarantined at home during the COVID-19 pandemic, the report states—mainly because school rules and norms that are designed to govern student activities and behaviors can conflict with the steps students need to take for their diabetes.

Some of the main areas where challenges were identified are listed below.

• When and where students can check their blood glucose. Restrictions on using devices during class times, carrying additional supplies or bags, and steps to avoid disrupting teaching can all cause conflict for students with diabetes. In the study, many students recount being restricted regarding access to their diabetes monitoring or treatment tools, or with the times and frequency in which they can use them. In many cases, school rules and the requirements of diabetes management are in direct conflict with one another, students shared.
• Addressing stigmas and relationship roles. The goal of many of the rules that govern a school day is to provide time and space for learning and to limit disruptions. Alerts, warnings, and even scheduled interventions for diabetes care are not easily worked into this structure, and this can result in conflict between students with diabetes and their peers or teachers. Many students shared experiences of being chastised for using phone and other devices for diabetes care, or for disturbing teaching when alerts or alarms go off.
• Managing the role of caregivers and parents during the school day. The school day is a time when interactions are usually limited to students and teachers or administrators. When caregivers or parents reach out because diabetes devices shared abnormal readings with them, this often increases the strain children with diabetes face. Parents and caregivers are able get information from remote monitoring throughout the school day because of advances in technology. However, it can be difficult to know information about your child’s glucose level without intervening, and parents and student might not always welcome this involvement or interruption during the school day. Many students in the study say that their parent or caregivers’ involvement in their school-day diabetes management actually made carrying out interventions and dealing with stigma from others even more difficult.

Although this study didn’t focus on delivering measurable data, or numerical results, it was able to show that the institutional structure of today’s schools and the requirements of a successful diabetes management plan are not always compatible. The study urges schools to do a better job at tailoring school structure around the devices and interventions a students’ needs to use to manage their condition. Likewise, the authors suggest that device developers could do a better job of creating tools for diabetes management that reduce interruptions in the typical school day and structure without compromising medical care.

Developing better processes for diabetes management in the school setting can help this population, but also others dealing with chronic disease management in schools achieve better balance, the study concludes.

Reference:

Puckett C, Wong, JC, Talbot S, et al. Institutional role conflict in the digital age: The case of diabetes management at school. SSM Qual. Res. Health. June 2023;3:100215. doi: 10.1016/j.ssmqr.2022.100215.