Back-to-School with Diabetes: What the Experts Say

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Summer days are winding down; it’s almost time for school to start.

Parents, educators and other caregivers—including members of the type 1 diabetes (T1D) community—are all wondering: “Is it safe to go back?”

“If I knew the answer to that, I might get a Nobel Prize,” joked Fran Kaufman, MD, Pediatric Endocrinologist and Chief Medical Officer with Senseonics.

Dr. Kaufman was one of five expert panelists who participated in a recent “Returning to School with Diabetes” virtual town hall.

Co-hosted by the American Diabetes Association (ADA), JDRF and Sansum Diabetes Research Institute, the event addressed some of the most pressing questions weighing on the minds of T1D parents and educators alike.

“In the end, this is going to be somewhat of an individual decision by you, your spouse, your child, your healthcare provider—hopefully diabetes specialist—and any other resource you might use to help with this decision making,” Dr. Kaufman continued.

“I think as individual parents, you’ll need to see what is the school providing. What are the physical measures they are taking to keep our children as safe as possible. I think a unique aspect for the parent of a child with type 1 diabetes–particularly in the lower elementary school grades—is what’s the ability to help that child with diabetes while they are in school?”

During the approximately hour-long virtual town hall, audiences heard from other experts:

  • Christa Singleton, MD, MPH (Master of Public Health) and senior medical advisor for the Centers for Disease Control and Prevention
  • Crystal C. Woodward, MPS (Master of Professional Studies) and director of the ADA’s Safe at School Campaign
  • Joyce Boudoin, a T1D parent and ADA advocate
  • Leah Wyckoff, MS (Master of Science), BSN (Bachelor of Science in Nursing), RN (Registered Nurse), NCSN (Nationally Certified School Nurse) with the Barbara Davis Center for Childhood Diabetes at the University of Colorado School of Medicine, and ADA Safe at School Working Group member.
  • Dr. Kristin Castorino (Panel Moderator), Senior Research Physician at Sansum Diabetes Research Institute
Social Distancing at School

Dr. Singleton addressed another significant concern about potentially returning to in-person attendance: the challenge of adhering to the CDC’s social distancing recommendations.

“For a school setting, we hope the school would be able to space children in seating arrangements and movement arrangements (such as moving in the hallways, etc.) so that they remain 6 feet apart,” Dr. Singleton said before mentioning the other two CDC recommendations for preventing the spread: proper hand hygiene and consistent use of face coverings by everyone over the age of 2.

“I am very concerned that we in the community do all that we can to protect our community, our children and our families during this very challenging time,” Dr. Singleton stressed.

Your Child’s Rights Don’t Go Away

“I want to make sure that you understand your children have legal protection—even during a global pandemic,” said Woodward, director of the ADA’s Safe at School Campaign and the parent of a now adult daughter who was diagnosed with T1D at the age of 17 months.  

“The rights of students with diabetes do not change—they do not go away—during the global pandemic,” Woodward emphasized.

No matter the model (full time remote; in-person attendance, or a hybrid), Woodward said, “Accommodations should stay in place for the student.”

These can be everything from allowing for extra absences or tardies for students with T1D; blood glucose monitoring at any time, any place; or needing to take a test at an alternate time if a student is experiencing blood glucose levels that are out of range at test time.

“They (the accommodations for children with diabetes) also include the ability of the student to have full participation in all extracurricular, school-sponsored activities,” Woodward said, listing off varsity sports, drama club and science club as a few examples.

But full participation isn’t where it stops, according to Woodward.

“There should be a trained coach, teacher, mentor—someone else on the premises who is available to respond to that child,” she said.

“But we have to be open minded—there are so many unknowns,” Woodward concluded.

Fears of Getting Lost in the Shuffle

Boudoin, whose T1D daughter is in high school, expanded on the vast number of unknowns and her worries as a T1D parent.

“I’m concerned about all the planning for diabetes management and care for children with diabetes getting lost in the shuffle,” she said.

Boudoin talked about the different protocols for healthcare at schools that had been put into place, noting that each school may have a different approach—some have school nurses, while others may have health clinic aides or other professionals providing care to students.

“Some of us have built good relationships with those providers or caregivers over the years, so the (potential for) turnover concerns me,” she said.

Boudoin also cited school healthcare provider burnout as a concern, given that in addition to their normal responsibilities, their schools would be looking to them to help prevent the spread of COVID-19.

How Should Schools Train for Safety?

Wyckoff, who in addition to her expansive nursing credentials is a retired school nurse, took on the topic of how schools should prepare to implement safety practices.

“This is going to vary, depending on what school or school district you’re in,” she said. “I’m going to give some key points of what to ask and what to look for.”

First and foremost, Wyckoff stated that staff need to be trained well in advance of the start of the school year.

“They need to have a practice run of these processes,” she said. “This should include care of the student with chronic health conditions such as diabetes.”

“They need to make sure they have the personal protective equipment (PPE) they need. Some of the important training components should be about using PPE.”

Wyckoff acknowledged that PPE use and safety measures should include face covering use in different environments (ex: classroom versus playground), hand hygiene and respiratory etiquette (what do you when you cough, for example).

“These things need to be covered with the staff and with students as well,” she emphasized.  

The panel addressed numerous other questions, including some at the end of the program that had been submitted by audience members.

Watch the full recorded livestream of the virtual town hall below:

For additional information about diabetes and school, consult the ADA’s Safe at School resources, JDRF’s School and T1D resources (made possible in part through the support of Lilly Diabetes), and School resources from our partners at Beyond Type 1.                         

For additional information about diabetes and COVID-19, consult guidelines collected and presented by the JDRF-Beyond Type 1 Alliance as well as Sansum Diabetes Research Institute’s COVID-19 and Diabetes resources.