School-based diabetes interventions and their outcomes: a systematic literature review

Type 1 diabetes is one of the most common chronic childhood diseases, while type 2 diabetes in children is increasing at alarming rates globally. Against this backdrop, the school is a critical environment for children with diabetes. They continue to face barriers to education that may lead to depression, poor academic performance, and poor quality of life. To address these challenges, diabetes interventions have been implemented in school and the goal was to systematically review these interventions and their outcomes between 2000 and 2013. Fifteen studies were included in the narrative synthesis. Education of school personnel was the main focus before 2006. Studies reported gains in knowledge and perceived confidence of school staff. Since 2006, more comprehensive interventions have been developed to promote better care coordination and create a safe school environment. These studies reported improved diabetes management and quality of life of students. Assessment tools varied and study design included randomized controlled trials, quantitative and qualitative methods. Although many of the studies reported a significant difference in the parameters measured, it was not possible to determine optimal ways to improve the health, quality of life and academic performance of children with diabetes, given the disparity in scope, assessment tools and measured outcomes. Experimental designs, longer follow-up studies, larger sample sizes, and a higher number of participating schools are critical issues to consider in future studies. Most of the research was conducted in North America and further research is needed in other parts of the world. Significance for public healthDiabetes is one of the most common chronic childhood diseases; both type 1 and type 2 diabetes are increasing in children globally. Against this backdrop, the school is a critical environment for children with diabetes. This systematic literature review on school-based diabetes interventions and their outcomes demonstrates that increasing efforts are being made to improve diabetes care and create a safe school environment. Studies reported gains in knowledge and confidence of school staff, as well as improved health and quality of life of students. Given the disparity of the assessment tools used, it was not possible to determine optimal ways to improve the health, quality of life and academic performance of children with diabetes. Future evaluations should include experimental designs, longer follow-up studies, and larger sample sizes. School-based diabetes interventions and solid evaluations will contribute to improving diabetes school policies and ensuring children with diabetes have the same educational opportunities as other children.