CONTROL ID: 2728893
TITLE: PROBLEMS FACED BY TYPE 1 DIABETICS AT SCHOOL AND UNIVERSITY LEVEL AND HOW TO OVERCOME 
CURRENT CATEGORY: Hypoglycemia
AUTHORS (LAST NAME, FIRST NAME): Jhingan, Ram M.2; Jhingan, Ashok K.3; Gupta, Astha1
ABSTRACT BODY:
Objective: Type 1 diabetes is a serious condition that affects the patient both academically and psychologically. Children with T1DM have to face challenges during every stage of their life. This adversely affects their psycho-social well-being, academic performance and confidence, leading to increased stress and ultimately worsening the disease condition. It is important to have a detailed understanding of diabetes and its complications at the level of school teachers and the policy makers.
Methods: A study was undertaken after parents of children with T1D at Delhi Diabetes Research Centre (DDRC) reported declining academic performance. This initiative was taken to assess the impact of diabetes on the academic performance and ways to improve it. We conducted an observational study involving 42 children with T1D. There were 23 girls and 19 boys in the age group of 10-15 yrs. We proposed hypoglycemia during examination as the main contributing factor. We studied self-reported outcomes of performance and hypoglycemia during exams.
There were extensive counselling sessions with the teachers and the parents about diabetes the symptoms of hypoglycemia and the dos and don’t’s when a child suffers from hypoglycemia. The teachers were instructed to allow children to carry Glucose Tablets (GT) with them during examinations. 
Following this, a children's questionnaire was conducted, as below:
Did you need to take GT and did symptoms improve?
Were you able to perform better in the examination time?
Do you feel more confident in facing exams with above provision?

Results: 19 children reported hypoglycemia which was verified by finger-stick glucose test. 11 children reported hypoglycemic symptoms only but no glucose testing was done. All of 30 children reported symptomatic improvement after eating GT. 12 did not report any sugar problem during exam.
All children reported improvement in confidence and self-reported exam performance after implementation of above program.

Discussion: As per the counselling sessions, there is a lack of awareness about diabetes, its complications and the symptoms of hypoglycemia. Increasing awareness can lead to appropriate measures being taken during hypoglycemia episodes. These measures will help children achieve their true potentials and reassure their parents.
Conclusion: Diabetes associated with repeated hypoglycemic episodes affects academic performance and hamper the confidence in children. Based on our observations, the Central Board of Secondary Examination (CBSE) of India has now permitted children with T1D to carry glucose tablets/snacks/water with them at all times during examinations. They have also agreed to our draft for Medical certificate which will be submitted by their physician to school and board of examinations. These changes will benefit the diabetic children in over 18000 schools in India and 200 schools abroad under CBSE. At the same time, the above recommendations have been proposed at the university level for children appearing in the graduate and post-graduate examinations
These initiatives will have a significant impact on the performance of the children and at the same time will help in reducing the apprehensions of the parents. We suggest that apex bodies like IDF also issue guidelines based on our observations so that all children with T1D in the world can avail these benefits. 

INSTITUTIONS (ALL):
1. Einstein Medical Center, Philadelphia, PA, United States.
2. Endocrine Associates, Plymouth Meeting , PA, United States. 3. Delhi Diabetes Research Center, New Delhi, New Delhi, India. Abstract Details

Challenges faced by type 1 diabetics at school and university level and way forward support for desired outcomes