Nataša Bratina, Slovenia
University Childrens Hospital Departement of endocrinology, diabetes, metabolismModerator of 1 Session
Presenter of 1 Presentation
Closed-loop in school
Abstract
Background and Aims
Epidemiological research is showing that the incidence of type 1 diabetes in childhood is increasing with 3-4% on yearly basis all over the world. Many reports also show an that the age at diagnose is decreasing. So we must be aware that the number of children with T1D that need support in kindergarten or school is increasing. Diabetes can enter in life of babies, children and adolescents in different moments. Children can also, as their parents feel fear, worries and uncertainty which are caused by symptoms and the diagnose of diabetes. Because of diabetes children can miss out school, they can feel misunderstood by their friends and schoolmates.
In many countries children stay in schools more than 8 or 10 hours daily, having two or three meals in the school environment, which is a significant proportion of their time, and a serious reason to optimize diabetes treatment at school; otherwise these children will have a poor metabolic control.
And without support from their caregivers, if coping strategies fail to function, the fact that diabetes is a serious illness, can result in developing signs of depression, anxiety in these groups of children.
Methods
Technological advances in the modern diabetes treatment with new insulin pump generations, continuous or flash glucose monitoring are entering to most of the countries, challenging children, their families but also caregivers and teachers. Children need support not only in blood glucose measuring, injecting insulin or deciding about the insulin dose, nowadays they are dealing with pumps, internal pump calculators and real time subcutaneous glucose monitoring next to intermittently scanned continuous glucose monitoring systems with complicated rules of carbo counting, and can be overwhelmed by the number of information’s technology brings. This all together make the need for support in school as one of the priorities for a complete care for these children.
Education of school personnel, sports trainers, and other teachers tis a must! Without proper education caregivers can be confused with dietary needs, different types of glucometers, pen injectors, insulin pumps and also continuous glucose monitoring systems. When they first meet the child with diabetes the fear of acute complications can be extreme and can change their decisions when dealing with diabetes.
The school must understand that the child needs a safe place to perform blood glucose measurements, insulin injecting, a proper diet is important (the importance of carb counting must be emphasized) as well and technically skilled caregivers to support the youngest using the pump and the sensor as well.
Results
A small survay was started in Slovenia to get informations who enters the educational program for schools, that started in 2004. 168 caregivers shared their answers, giving to the educational program an avarage note of 4,5 out of 5 points. They emphasized that more informations in the field of dietary counseling, psychological background is needed, next to practical workshops and more informations about the sensor and the pump with the possibility of reeducation.
Profile | Teacher 76 | Caregiver 35 | Personal assistant 24 | Dietetic counseling 16 | Social worker 18 |
Age of the child | <5 years 38 | 5-10 years 92 | Ø10 years Ø Ø38 | ||
Age of the caregiver | < 25 3 | 25-34 50 | 35-44 52 | 45-54 36 | Ø55 Ø Ø27 |
Sex of the participant | Female 160 | Male 8 | |||
Stress? | Very high 110 | High 50 | Moderate 8 | ||
Sent by the school? | Yes 129 | No – my wish 39 | |||
Education | First time - 149 | More than once 19 |
Conclusions
Diabetes teams / families / caregivers should perform team work, school stuff should be well educated, responsibility on administering medication must be recognized and roles and responsibilities clearly given. Individual Health Care Plans can be supportive, next to an emergency plan for hypo/hyperglycemia with exact instructions for severe hypoglycaemia and early recognition of ketoacidosis.