Diabetes Care of Children With Type 1 Diabetes at School: Factors Related to the Choice of Care Location and Association With Glycemic Control.

Objective

Type 1 diabetes (T1D) management in children requires a comprehensive approach tailored to developmental stages and school environments. This study investigated the locations of self-management behaviors at school, examining factors influencing location choice and their associations with glycemic control. RESEARCH

Design

AND

Methods

This multicenter, cross-sectional study analyzed 2018 registration data from 1,105 children with T1D attending schools or preschools in Japan. Associations among HbA1c, care behaviors, locations, treatment modalities, age, and sex were statistically evaluated.

Results

The mean (SD) HbA1c was 8.01% (1.12%) (64.0 [12.2] mmol/mol). Care locations were the classroom (36.9%), designated rooms (52.6%), and the restroom (5.9%). HbA1c was significantly higher in the restroom group at 8.56% (0.98%) (70.1 [10.7] mmol/mol) than in the classroom group at 8.00% (1.20%) (63.9 [13.1] mmol/mol) and designated room group at 7.95% (1.08%) (63.4 [11.8] mmol/mol) (P < 0.001). Restroom use and omitting prelunch blood glucose monitoring were independently associated with higher HbA1c. Pump use, continuous glucose monitoring, and male sex predicted higher classroom use and lower restroom use. Joinpoint analysis showed that classroom use declined after age 6 (elementary school entry), whereas restroom use emerged from age 11 and spiked markedly at age 16 (20.8%), coinciding with high school entry, even among pump users.

Conclusions

Care location choice shifts dynamically with age and school transitions, with restroom use being linked to poorer glycemic control. Supporting youth during school transitions requires targeted environmental adjustments and enhanced school-wide understanding to ensure safe and appropriate care locations.