Anne Belton and Bénédicte Pansier
Diabetes is increasingly becoming a more common health threat for young people across the world, demanding local communities — particularly those in low- and middle-income countries — to execute measures that will ensure young people with diabetes can live equally rich and fulfilling lives as their peers. In collaboration with select partners, the International Diabetes Federation has developed a project designed to support children’s rights, ensuring school days are happy days for the diagnosed, and encouraging healthy behaviours among all school-aged children worldwide.
In June 2013, IDF, in collaboration with the International Society for Paediatric and Adolescent Diabetes (ISPAD) and Sanofi Diabetes, launched the Kids and Diabetes in Schools (KIDS) project. KIDS, as a multi-stakeholder initiative, aims to foster a safe and supportive school environment for children with diabetes to manage their diabetes and fight discrimination. The fundamental rights of children living with diabetes include the freedom to access care and support to manage diabetes appropriately and to be fully included and engaged in all school activities to achieve their full potential. KIDS also aims to raise awareness of diabetes and promote healthy diet and exercise habits in the school community.
Implementing and integrating KIDS into school communities successfully requires serious commitment from policy makers and education authorities; completion of situational analyses summarizing opportunities and challenges; execution of a fully-fledged school awareness campaign; and development and introduction of a diabetes school information pack and teacher training for selected countries. IDF’s Young Leaders in Diabetes Programme will lend support and help disseminate the KIDS packs when the project kick-starts in Brazil and India, our two pilot countries.
At the end of the first phase of the project (18 months), a Global Diabetes in Schools Toolkit will be developed and made available to IDF Member Associations to roll out the project after the pilot launch in other successive parts of the world. In the second phase, KIDS aims to achieve government support for systemic change for children with diabetes in schools including dissemination of national guidelines.
Global threat of childhood diabetes
Type 1 diabetes is one of the most common chronic childhood diseases, affecting an estimated 490,000 children under 15 years. The incidence of type 1 diabetes among children is increasing in many countries and approximately 78,000 children under 15 years are estimated to develop type 1 diabetes annually worldwide.1-3
Young people today also face another danger that threatens their ability to attain a healthy and successful future. Evidence shows that type 2 diabetes is also increasing in children and adolescents around the world at alarming rates. With rising levels of childhood obesity and physical inactivity in many countries, type 2 diabetes in childhood has the potential to become a global public health issue.4-6
Against this backdrop, the school system is a vitally important environment for children with diabetes, especially as it relates to day-to-day self-management care and total well-being. Schools perform a critical role supporting and educating children with diabetes so they have the same opportunities afforded other children, such as participating in the classroom or playground.
IDF leadership for childhood diabetes
In March 2005, IDF released a position statement on the Rights of the Child in the School declaring that children have the right to manage their diabetes without being excluded or discriminated against7 in the school setting. The Position Statement calls for all children with diabetes to have an individualized diabetes plan developed in a collaborative approach with healthcare providers, school staff and the family.
Numerous guidelines and educational materials on diabetes in schools for teachers, parents and children have been made available in several countries.8-11 Effective campaigns about diabetes management in schools include the Australian Diabetes Council’s ‘Diabetes kidsandteens Careline’ (2006), the American Diabetes Association’s ‘Safe at School’ Campaign (2011), Diabetes UK Children's Campaign ‘Let's Talk Type 1 Diabetes in Schools’ (2011), the IDF and its Italian Member Association’s ‘Good Diabetes Control’ campaign for schools (2012/2013) and the Diabetes Program at Schools in Turkey (2012).12
Despite this work, evidence suggests that many children and adolescents with diabetes continue to face barriers to education and endure discrimination and stigma, in particular in low- and middle-income countries. School and national policies don’t often recognize the special needs of a child living with diabetes. Lack of the assistance needed to monitor blood glucose, administer insulin and treat emergency situations (e.g. hypoglycaemia) can result in the child being excluded from school activities. Some schools believe they reserve the right to deny access to a child with diabetes and even when allowed to matriculate, some children are barred from participating in extracurricular activities.13-16 Ignorance and misconceptions about diabetes held and fostered by school personnel, fellow students and parents of other students are often at the root of such stigma and discrimination. Furthermore, a school classroom may not provide clean and adequate space to support self-management tasks such as testing blood glucose, storing snacks, injecting insulin or storing equipment for injections or lancets for blood glucose testing.
Endpoints of KIDS - Phase 1
The IDF KIDS project will begin with a feasibility study supported by two local implementing partners, the IDF Member Association Associação de Diabetes Juvenil (ADJ) in Brazil and the Public Health Foundation of India (PHFI). This feasibility study will identify and engage with relevant stakeholders at national, regional and local levels, review existing guidelines and initiatives on diabetes in the school environment and carry out a needs assessment in the two countries. The results are expected by September 2013.
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