Type 1 diabetes self-care in urban schools in India

Objectives: Children with type 1 diabetes (T1D) need a supportive, non-stigmatizing school environment for self-care activities such as checking blood glucose (BG) and taking pre-meal insulin. Data about T1D self-care in schools in developing countries are scarce. We looked at diabetes self-care activities at school, and attitudes of school staff toward diabetes care. Material and Methods: We interviewed, over an 8-week period, consecutive patient-parent dyads attending T1D clinics in North (Delhi, Gurgaon, and Kanpur), West (Aurangabad), and South (Hyderabad) India. Results: We received responses from 397 patients, 51% of boys. Mean age was 11.7 years (SD: 3.7), mean age at diagnosis 7.2 years (SD: 3.7), and mean diabetes duration 4.5 years (SD: 3.5). A majority (69.8%) were attending private (fee paying) schools (PS) and the rest were studying at government (subsidized/free) schools (GS). More than half of the parents had high educational status: graduate or more (mothers: 52.1%, fathers: 56.9%). Parents visited school daily in 17.1%, significantly more if they had high educational status and if the child was <6 years. Less than half (47.4%) were administering a pre-meal insulin bolus at school (self-injection: 33%, by parent: 12.9%, and by staff: 1.5%); only 24.4% were checking BG regularly (< once per week) at school. The odds of performing diabetes self-care activities at school were significantly higher in children attending PS compared to GS (OR: 3.17, 95% CI: 1.99–5.03 for taking insulin, OR: 3.24, 95% CI: 1.75–5.98 for regular BG checking). The odds of taking insulin at school were also higher with higher parental education (OR: 2.81, 95% CI: 1.87–4.24 for mother’s education, OR: 3.02, 95% CI: 1.99–4.57 for father’s). Testing and injecting we done in classroom (26.2%); medical room (16.1%), staffroom (7.8%), or toilet (2.5%). School insisted on secrecy in 12.6%, excluded children with T1D from sports/excursions in 17.9%, refused permission for injecting in 4.3%, for testing 15.9%, and for pre-activity snack 7.6%. This non-supportive behavior was equal in PS and GS. PS had slightly better care infrastructure such as availability of glucometer (29.6% vs. 3.3%), sick room (21.7% vs. 0.3%), and dedicated nurse (9.7% vs. none). Conclusion: Half of our children were able to manage T1D self-care in school, as schools were often supportive, whether private or government. Parental educational status was positively associated with better care. Although self-care was better in PS and they had better infrastructure, there is much scope for improvement.

Arthur Conan Doyle 1894–1899

This chapter shows Arthur Conan Doyle busy on many different fronts: looking after his tubercular wife Touie; the setting up of a large household in Surrey; adventures as a journalist with the British army in Egypt; always writing. He struck a deal with American actor/playwright William Gillette for a stage version of Sherlock Holmes, which was hugely successful and lucrative. While Touie was confined to a sick room, Doyle fell in love with a much younger woman. When war broke out with the Boer Republics, Doyle championed the uitlanders, the foreigners in the Transvaal. His sense of fair play and his patriotism motivated a desire to enlist; turned down for soldiering, he secured a post as physician with Langman’s Field Hospital.