Hellems Martha A, Clarke William L
Division of General Pediatrics, Department of Pediatrics, University of Virginia, Charlottesville, Virginia 22908, USA.
Diabetes Care. 2007 Jun;30(6):1396-8. doi: 10.2337/dc07-0121. Epub 2007 Mar 10.
The Commonwealth of Virginia passed legislation in 1999 requiring nonmedical school personnel to assist students with the management of type 1 diabetes when school nurses were unavailable. This study was designed to determine which school personnel in Virginia currently assist type 1 diabetic students with insulin administration and management of hypoglycemia and to determine if these students are being cared for in a safe manner.
Parents of children with type 1 diabetes who attended public school in Virginia during the previous year and who were receiving their diabetes care at the University of Virginia diabetes clinics were asked to participate in an anonymous survey. The survey asked parents which school personnel were responsible for their child's diabetes care while at school and which persons helped with specific care tasks including blood glucose monitoring, insulin administration, and assistance with treatment of hypoglycemia. Questions were asked regarding the occurrence and treatment of hypoglycemia and any adverse effects of such treatment.
A total of 185 parents whose children attended 153 different schools responded, 69% of whom reported that a full-time school nurse was assigned to their child's school. In other schools, teachers, administrators, coaches, and cafeteria workers supplemented part-time nurses in assisting students with diabetes management tasks. Although hypoglycemia was not a rare event (75% of students experienced a median of five episodes per year), only one severe event requiring the use of glucagon was reported. In that case, glucagon was administered appropriately by a part-time school nurse, and the student experienced no adverse effects related to the treatment.
Students with type 1 diabetes can be cared for safely during the school day by a variety of trained medical and nonmedical personnel. The occurrence of one severe hypoglycemic event among 185 students suggests that as many as 3% of students could experience severe hypoglycemia in a given school year. Legislation that permits nonmedical school personnel to assist students with their diabetes management could make the diabetic children's school day safer and improve their overall glucose control.
弗吉尼亚州于1999年通过立法，要求在学校护士无法提供服务时，非学校医护人员协助学生管理1型糖尿病。本研究旨在确定弗吉尼亚州目前哪些学校人员协助1型糖尿病学生进行胰岛素注射和低血糖管理，并确定这些学生是否得到了安全的护理。
邀请前一年在弗吉尼亚州公立学校就读且在弗吉尼亚大学糖尿病诊所接受糖尿病护理的1型糖尿病患儿家长参与一项匿名调查。该调查询问家长，孩子在学校时哪些学校人员负责其糖尿病护理，以及哪些人员协助完成包括血糖监测、胰岛素注射和低血糖治疗协助等具体护理任务。还询问了有关低血糖的发生与治疗以及此类治疗的任何不良反应的问题。
共有185名家长回复，其孩子就读于153所不同学校，其中69%报告称孩子所在学校配备了全职学校护士。在其他学校，教师、管理人员、教练和食堂工作人员在协助学生进行糖尿病管理任务方面补充了兼职护士的工作。尽管低血糖并非罕见事件（75%的学生每年平均经历5次发作），但仅报告了1起需要使用胰高血糖素的严重事件。在该案例中，兼职学校护士正确使用了胰高血糖素，学生未出现与治疗相关的不良反应。
1型糖尿病学生在上学期间可由各类经过培训的医疗和非医疗人员安全护理。185名学生中发生1起严重低血糖事件表明，在给定学年中多达3%的学生可能会经历严重低血糖。允许非学校医护人员协助学生进行糖尿病管理的立法可使糖尿病儿童的上学日更安全，并改善他们的整体血糖控制。
