World diabetes body worried about young sufferers

Children with diabetes around the globe, including Malta, are often unable to manage their condition at school without being excluded, a situation that has raised the concern of the International Diabetes Federation.

The IDF held the position in a recent statement that children and adolescents "must be able to manage their diabetes in the school setting without being excluded or discriminated".

In Malta, about 10 per cent of the population has diabetes, with one per cent suffering Type 1 diabetes, a condition that usually affects children or adults up to 35 years of age.

A recent parliamentary question shows that at present the number of children or adolescents aged 0 - 20 years attending government health clinics for diabetes stood at 147. This figure excludes those attending private clinics.

The federation, the only global advocate for people with diabetes and their healthcare providers, says that appropriate care is required for children in order for them to be safe, improve their long-term well being and achieve their academic potential.

It advocates that children have the right to manage their diabetes at school and this includes the right to: monitor the blood glucose levels; follow a regular meal plan; participate in physical activity programmes; take medications and treat emergency situations.

"Children unable to perform self-management should have the right to receive appropriate supervision and to be aided in diabetes management tasks," the IDF said in a position statement.

To ensure safety, school personnel must have an understanding of diabetes and there must be individuals trained in relevant aspects of diabetes care and the treatment of diabetes emergencies. Diabetes management must be allowed to occur in the least restrictive environment and without discrimination.

When contacted to comment on the IDF's position statement, the Maltese Diabetes Association said that unfortunately this situation existed in Malta and it had experienced cases of discrimination with its juvenile diabetic members in the past.

"These ranged from persons being excluded from sports activities and others not being allowed to attend school outings unless accompanied by a parent," the association said.

The association said that while it did not expect the school personnel to administer drugs, it felt it was their duty to supervise diabetic students, particularly the younger ones, following guidelines given by the parents at the beginning of a scholastic year.

"This may simply involve the provision of a sugary drink when the student's blood sugar levels are low or a telephone call to the student's parent if the latter is showing signs of a low blood sugar level such as sweating, change in mood and other similar symptoms," the association added.

It endeavours to educate society on diabetes including teachers and educators. In the past, through the Ministry of Education, the association was invited to deliver talks to teachers in government schools to provide them with first-hand information on the symptoms a diabetic student could show and what emergency action they should take.

"Diabetic students already suffer psychologically because of their condition. Being excluded, treated differently from any other student or making their life difficult because of diabetes will definitely make matters worse," the association concluded.

The International Diabetes Federation's position statement

The IDF is the only global advocate for people with diabetes and their healthcare providers. It works together with its member associations to enhance the lives of people with diabetes worldwide. It is a non-governmental organisation in official relations with the World Health Organisation and the Pan American Health Organisation.

Its mission is to promote diabetes care, prevention and a cure worldwide. Since it first took up the diabetes cause in 1950, it has evolved into an umbrella organisation of 187 member associations in 148 countries.

In its position statement on The Rights of the Child with Diabetes in the School, the IDF believes that for the appropriate diabetes care of students the following conditions are necessary:

¤ A Diabetes Healthcare Plan must be devised in collaboration with healthcare providers, school personnel, the parent/guardian and the student. The following components must be addressed in the Diabetes Healthcare Plan:

1. Blood glucose monitoring, including frequency and circumstances of testing.

2. Administration of medication, including insulin, with specific reference to doses, timing of injections and storage.

3. Meals and snacks, including quality and quantity of food portions.

4. Prevention of hypoglycaemia.

5. The urgent treatment of hypoglycaemia, including the administration of glucagons for severe hypoglycaemia (if available).

6. Hyperglycaemia, including treatment in the school.

7. Testing for ketones and sick day management.

8. Management of emergencies.

¤ Responsibilities and cooperation of various stakeholders:

1. The parent/guardian is responsible for transmitting the Diabetes Healthcare Plan to the school and for bringing diabetes supplies, an emergency plan and diabetes information to the school.

2. The school is responsible for training of an adequate number of personnel, for accessibility to supplies (particularly for hypoglycaemic emergencies) and for supervision or execution of diabetes tasks so that the Diabetes Healthcare Plan can be carried out.

3. The student is encouraged to perform the tasks that are appropriate for his/her age and developmental stage and to actively cooperate with school personnel.

¤ The IDF encourages all measures and actions that contribute to a better management of diabetes in the school. It also recommends a cooperative and collaborative approach by all stakeholders to ensure that children with diabetes are able to manage their diabetes in the school setting without being excluded or discriminated.