Peer-reviewed article
Diabetes Care of Children With Type 1 Diabetes at School: Factors Related to the Choice of Care Location and Association With Glycemic Control.
Matsui K, Nemoto C, Tagawa K, Nagai S, Fukawa K et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined where children with type 1 diabetes manage their condition during the school day in Japan, involving 1,105 children. Children who used restrooms for diabetes care had worse blood sugar control than those using classrooms or designated rooms. The choice of care location changed with age and school transitions, with restroom use increasing sharply when children entered high school at age 16.
Key points
- Mean HbA1c was 8.01%, with the restroom group showing significantly higher HbA1c (8.56%) compared to classroom (8.00%) and designated room groups (7.95%)
- Care locations varied: designated rooms were most common (52.6%), followed by classrooms (36.9%) and restrooms (5.9%)
- Restroom use and skipping prelunch blood glucose monitoring were independently associated with higher HbA1c levels
- Classroom use declined after age 6 (school entry), while restroom use emerged at age 11 and spiked to 20.8% at age 16 (high school entry)
- Pump users and those on continuous glucose monitoring were more likely to use classrooms rather than restrooms
Limitations
The study is cross-sectional, so it cannot establish causation between care location choice and glycemic control; it does not explain the reasons why students choose particular locations or the barriers they face in accessing preferred care settings.
Abstract
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.