Traditional school day schedule benefits children with type 1 diabetes

HALIFAX, Nova Scotia — Children with type 1 diabetes who have a balanced school day schedule, which includes two 45-minute breaks, have worsening glycemic control compared with those on the traditional school schedule, which contains three breaks, according to retrospective research presented here.

Perspective from Jill Hamilton, MD, FRCPC

Investigators compared 53 students with type 1 diabetes (mean age, 11 years) on the traditional school schedule with 64 (mean age, 10 years) who were on the balanced school day schedule.

“To our knowledge, there has not been another study that has looked at glycemic control within the balanced school day,” said Manpreet Doulla, MD, a fellow at Alberta Children’s Hospital, Calgary, Alberta, who completed the research while based at Western University in London, Ontario.

Doulla and colleagues hypothesized that children with type 1 diabetes who require insulin injections three times daily and were on the balanced school day schedule would have poorer control than similar children who were on the traditional school schedule.

“For children on a three times-a-day insulin regimen, their insulin would typically peak around noon, which would be [when they are] having their carbohydrate [intake] in the traditional schedule, but in the balanced school day they would not,” Doulla said.

Investigators saw a nonsignificant rise in HbA1c, representative of the summer (summer HbA1c) months among students on the traditional school schedule. They saw a significant within-group rise from summer HbA1c to HbA1c occurring at least 3 months after the start of the school year (school HbA1c) among children on the balanced school day schedule, with HbA1c values increasing from 7.9 to 8.5.

“We found a within-group increase that was present only in the balanced school day group [of students], which was about 0.6%, and it was both statistically and clinically significant,” Doulla said. “The findings suggest these children appear to have worsening of their diabetes, but we are not drawing a causal relationship between the balanced school day and glycemic control because of the limitations of the study.”

Investigators did not measure physical activity changes, Doulla said.

Doulla said the data suggest individual care plans for children with type 1 diabetes could be implemented to help mitigate the effects that the balanced school day has on their diabetic control. – by Louise Gagnon

Reference:

Doulla M, et al. Oral Abstract 4. Presented at: Canadian Pediatric Endocrine Group Scientific Meeting; Feb. 19-21, 2015; Halifax, Nova Scotia, Canada.

Disclosure: Doulla reports no relevant financial disclosures.

Perspective

Jill Hamilton, MD, FRCPC

This is an interesting study comparing groups of children with diabetes transitioning from summer months to the school year. One group entered schools that have a “traditional” midday lunch period, and the others entered schools with a “balanced lunch day,” ie, two lunch periods divided into midmorning and midafternoon. The group that participated in the balanced lunch day demonstrated a significant increase of 0.6% in their HbA1c level 3 months into the school year, whereas the other group did not see a change. This study highlights the potential impact of changing meal schedules and the effect this may have on metabolic control. Limitations include lack of information regarding “school” factors that may have affected diabetes routines, as well as potential patient differences between groups attending different schools. Nonetheless, as schools may have different times allotted for food consumption compared with home routines, clinicians and families should be aware of the potential impact on glycemic control so they can adjust insulin routines accordingly.

Jill Hamilton, MD, FRCPC

Staff physician in the Division of Endocrinology; director of the Centre for Healthy Active Kids; and Mead Johnson Chair in Nutritional Science at the University of Toronto, The Hospital for Sick Children.

Disclosures: Hamilton reports no relevant financial disclosures.