School nurses help kids control diabetes

NEW YORK (Reuters Health) - School nurses can help older children and adolescents with poorly controlled type 1, or "insulin dependent," diabetes better manage their blood sugar during the school day, research suggests.

In a pilot study lasting 3 months, researchers found that nurse-supervised blood sugar monitoring, insulin injections at lunch and periodic insulin dose adjustment as needed during school led to significant improvement in participants' hemoglobin A1C -- a standard indicator of long-term blood sugar control.

At the start of the study, all of the children had hemoglobin A1C levels of 9 percent or higher, indicating that their diabetes was not well controlled. The desired hemoglobin A1C level is below 7 percent.

At the end of the 3-month study period, the 18 subjects who took part in the nurse-supervised blood sugar control program had lowered their hemoglobin A1C level by a significant 1.6 percent, whereas hemoglobin A1C was unchanged in the 18 "control" subjects who continued their usual diabetes care and insulin regimen.

In the Journal of Pediatrics, the study team notes that school nurses "serve as an important resource, caring for the children's medical needs when at school. Previous studies show that they make a difference in children with asthma."

The current study suggests that a school nurse-led diabetes control program may be an "effective short-term strategy for managing children and adolescents with poorly controlled type 1 diabetes mellitus," conclude Dr. Rubina A. Heptulla and colleagues from Baylor College of Medicine and Texas Children's Hospital, Houston.

The investigators say further clinical trials are currently planned to determine the particular components of the school-based program that are most helpful and whether this intervention can be sustained long-term and lead to improved blood sugar control among "this difficult group of patients."

SOURCE: The Journal of Pediatrics, October 2008.