School Children with Diabetes: Study Finds Better Contr...

School Children with Diabetes: Study Finds Better Control with Higher Self-Responsibility

School Children with Diabetes: Study Finds Better Control with Higher Self-Responsibility

03 March 2009
Keith Syverson

Surveys have shown that the vast majority of teachers know of at least one student in their school with a chronic illness. Several studies have investigated the administration of medication in schools from the perspectives of principals or of school nurses, but few studies exist on how students and parents feel about this issue. A 2008 study in the Journal of School Nursing went directly to the source, interviewing students with diabetes, asthma, and ADHD in order to determine the "types of problems and mistakes [they] experience with their medicines at school." The group of researchers included pharmacologists and a professor of nursing. They reached conclusions that surprised them but correspond to modern recommendations for diabetes care.

The researchers initially assumed that the higher the level of responsibility a student has for his or her medication administration, the greater the child's "risk factor index" and the greater the chance of medication error. The authors state that this index is a combination of risk factors previously identified in the literature and "the collective clinical experiences of the authors." These included whether the child: transports his or her own medication to school, stores his or her own medication within reach, and whether the child self-administers his or her own medication. The researchers found that students with diabetes have the highest degree of self-responsibility and thus, as a group, have the highest risk factor index. Contrary to the initial assumption that a high degree of self-responsibility put the student at a high risk for medication errors, the researchers found that diabetic students had the lowest prevalence of medication error. In contrast, a higher prevalence of errors was reported among children with ADHD who had the least amount of self care responsibility.

The authors argue that this is a "positive finding in light of recent support for students with ... diabetes to be more involved in self management" and further suggest that "[p]erhaps children with diabetes should be given more responsibility." Such findings are consistent with the American Diabetes Association (ADA)'s Position Statement on Diabetes Care in the School and Day Care Setting, which suggests that students, to the extent possible, should manage their own care under the oversight of adults. Similarly, other studies have indicated that the flexibility for students to manage their diabetes in the school setting decreases anxiety and correlates with improved diabetes management.

Currently, seventeen states implicitly or explicitly allow a student with diabetes to provide some sort of self care to himself or herself (Alabama, California, Connecticut, Hawaii, Indiana, Massachusetts, Nebraska, Nevada, New Jersey, Oklahoma, Rhode Island, South Carolina, Tennessee, Texas, Utah, Washington, and Wyoming). The level of self care allowed to the student by statute varies. For example only ten states specifically allow self-testing of blood glucose levels (California, Connecticut, Indiana, Massachusetts, Oklahoma, Rhode Island, Tennessee, Texas, Utah, and Washington) and still fewer states allow the self-administration of insulin.

Students with diabetes who are not lucky enough to be residents of these 17 states may be at an increased risk for medication error in school because of their inability to exercise a proper degree of self care. These findings highlight the importance for passing legislation that allows students to properly care for themselves in the school setting.