Children with diabetes: Protecting our future - Global perspectives on diabetes

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Children with diabetes: Protecting our future - Global perspectives on diabetes
Global perspectives on diabetes               Volume 58 – September 2013

                                  Children with diabetes:
                                    Protecting our future
Children with diabetes: Protecting our future - Global perspectives on diabetes


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Children with diabetes: Protecting our future - Global perspectives on diabetes

      Diabetes Views                                                      4
                                                                               International Diabetes Federation
                                                                               Promoting diabetes care, prevention and a cure worldwide
      News in Brief                                                       6
                                                                               Diabetes Voice is published quarterly and is freely available

      T H E G LOBAL CA M PAI G N                                               online at

      My sweet family                                                     10   This publication is also available in French and Spanish.
      Aishath Shiruhana and Aminath Abdul Rahman
                                                                               The production of this Special Issue has been made possible
      Protecting kids' rights: IDF and select partners launch Kids and
                                                                               thanks to the support of Sanofi Diabetes.
      Diabetes in Schools (KIDS) project in Brazil and India           13
      Anne Belton and Bénédicte Pansier
                                                                               Editor-in-Chief: Rhys Williams
      In the spirit of patient centeredness                               16   Managing Editor: Isabella Platon,
      Angus Forbes                                                             Editor: Elizabeth Snouffer
                                                                               Advisory group: Pablo Aschner (Colombia), Ruth Colagiuri
      Prioritising diabetes on the global agenda                          19   (Australia), Maha Taysir Barakat (United Arab Emirates),
      Linong Ji
                                                                               Viswanathan Mohan (India), João Valente Nabais (Portugal),
      National programme in Turkey: Diabetes at School                    21   Kaushik Ramaiya (Tanzania), Carolyn Robertson (USA).
      Şükrü Hatun and Şeyda Özcan                                              Layout and printing: Ex Nihilo, Belgium,

      h e a lt h d e l i v e r y                                               All correspondence and advertising enquiries should be
                                                                               addressed to the Managing Editor:
      The role of diabetes technology in children and youth:                   International Diabetes Federation, Chaussée de La Hulpe 166,
      getting connected for better control                                24   1170 Brussels, Belgium
      Francine R. Kaufman                                                      Phone: +32-2-5431626 – Fax: +32-2-5385114 –
      Taming the diabetes monster                                         28
      Elizabeth Snouffer

      Children and diabetes: success and challenge                             © International Diabetes Federation, 2013 – All rights reserved.
                                                                               No part of this publication may be reproduced or transmitted
      in the developing world                                             31
                                                                               in any form or by any means without the written prior permis-
      Graham Ogle, Angie Middlehurst and Robyn Short-Hobbs
                                                                               sion of the International Diabetes Federation (IDF). Requests
                                                                               to reproduce or translate IDF publications should be addressed
      CLINICAL CARE                                                            to the IDF Communications Unit, Chaussée de La Hulpe 166,
                                                                               B-1170 Brussels, by fax +32-2-5385114, or by e-mail
      Debate – Insulin therapy: a matter of choice?                       34
      Psychological challenges for children living with diabetes          38
      Diana Naranjo and Korey Hood                                             The information in this magazine is for information purposes only.
                                                                               IDF makes no representations or warranties about the accuracy and
                                                                               reliability of any content in the magazine. Any opinions expressed
      Caregiver reports of provider recommended frequency of                   are those of their authors, and do not necessarily represent the views
      blood glucose monitoring and actual testing frequency for youth          of IDF. IDF shall not be liable for any loss or damage in connection
                                                                               with your use of this magazine. Through this magazine, you may
      with type 1 diabetes                                            41       link to third-party websites, which are not under IDF’s control.
      Joyce P. Yi-Frazier and colleagues for the SEARCH for Diabetes in        The inclusion of such links does not imply a recommendation or
      Youth Study Group                                                        an endorsement by IDF of any material, information, products and
                                                                               services advertised on third-party websites, and IDF disclaims any
                                                                               liability with regard to your access of such linked websites and use of
      DIABETES IN SOCIETY                                                      any products or services advertised there. While some information
                                                                               in Diabetes Voice is about medical issues, it is not medical advice and
      Encouraging healthy futures for Brazil’s children                   48   should not be construed as such.
      ADJ - Associação de Diabetes Juvenil
                                                                               ISSN: 1437-4064
      Voices of type 1 diabetes: taking type 1 diabetes to school         53   Cover photo : © GlobalStock |

      VOICE BO X                                                          58

September 2013 • Volume 58 • Special Issue 1                                                                                                  DiabetesVoice     3
Children with diabetes: Protecting our future - Global perspectives on diabetes
Diabetes views

        No More Excuses
          It always seems impossible, until it is done. – Nelson Mandela
         These words first uttered by Nelson Mandela seem particularly appropriate        Today, under the leadership of Graham Ogle, IDFs Life for a Child (LFAC)
         and current for what is most critical to the status of diabetes care in the      Programme helps 11,200 children and youth in 43 countries and provides
         world today, especially concerning human rights and survival. Mandela’s          them with essential care including insulin, test strips, and expert diabetes
         words reflect the pressure most nations, governments and municipalities          education. However, it is estimated that 80-100,000 children and youth
         must accept in order to improve the current state of care for all people         around the world are still in urgent need of assistance.
         living with type 1 or type 2 diabetes worldwide – especially children. With
         cautious optimism, and with the largest coalition of diabetes advocates          In 2011, IDF developed the first ever International Charter of Rights and
         behind us we must be ready to fight for and protect the fundamental              Responsibilities of People with Diabetes providing fundamental guidelines
         rights of each and every child living with diabetes. It may seem impossible      for the rights of more than 371 million people living with diabetes. This
         today, but it must get done.                                                     landmark document places the rights of people with diabetes, their
                                                                                          parents and carers into three focus areas: the rights to care; information
         There was a time when it seemed impossible to save the lives of children         and education and social justice, whilst at the same time acknowledging
         suffering from diabetes, that is until Drs. Frederick Banting and Charles        the responsibilities held by people with diabetes.
         Best, mentored by Professor Macleod and assisted by James Collip,
         discovered insulin in 1921. The first child successfully treated with            The Charter aims to bridge the gap in the quality of care as well as customs
         insulin took place in 1922 at Toronto General Hospital. Dr. Banting              and practice that impact the health of people with diabetes in many ways.
         injected 14-year-old Leonard Thompson, a ‘charity patient,’ with the             But there is so much more we need to get done for the promise of a healthy
         hormone insulin and Leonard survived, as so many children have done              future for the child living with diabetes.
         ever since. However, it also must be pointed out that even today many
         children do not thrive, and many die within weeks of diagnosis, if they          Children must have a voice. In order to have an understanding of their
         are even diagnosed at all.                                                       health requirements, our youth must be able to communicate their needs
                                                                                          and explain what aspect of diabetes is troubling them most so they can
         We must ask ourselves again and again how can it be that we live in a world      begin to live healthy lives with the promise of a future. For this reason
         where type 1 diabetes is still considered a death sentence, even though a        psychosocial counselling and care is key for the child who is not meeting
         life-saving treatment was discovered nearly a century ago?                       targets. This aspect may be especially apparent in adolescence and young
                                                                                          adult life well into the mid-twenties. Communication between doctor
         In 2006, landmark UN Resolution 61/225 was the first step toward                 and patient, counsellor and patient and parent or carer brings to mind
         advancing the rights of people affected by type 1 and type 2 diabetes.           the triangle of care. As a child develops into a young adult it is important
         Resolution 61 validated the debilitating and costly nature of diabetes.          that the right transitional care is chosen. We know that young adults and
                                                                                          adolescent children are more susceptible to complications. We cannot
         Tragically, within one year of Resolution 61, nearly 5000 children still         overlook the importance of teaching children living with diabetes to fight
         died from diabetes mellitus worldwide (WHO Global Burden of Death,               their condition and overcome perceived barriers. We must teach them to be
         2008). Even this shameful statistic is a probable inaccuracy due to under-       masters of the disease rather than its servant, but only with adequate care
         reporting, misdiagnosis and guilt. What is not alluded to in Resolution 61       and access to life-saving medicines can we begin to show them the way.
         is the multitude of children, from low- and middle-income countries, who
         develop diabetes and find themselves very much alone. Many of these              No child should die of diabetes, and we must ensure this gets done.
         children suffering with poorly treated diabetes are too afraid to reveal their
         condition to teachers or schoolmates and many won’t be afforded the same
         opportunities for career or life. The undiagnosed and neglected child who
         develops diabetes will not be satisfactorily cared for and now we know that
         care in the beginning is key to diminishing the risk for complications later
         in life. Most tragically of all, the child who develops type 1 diabetes, but
         who also lives in poverty, will die within 2 weeks without insulin.

         It is time that we ensure that medical standards for all children suffering
         with type 1 diabetes are met. It is time the provision of insulin is made
         accessible to all who might need it – but especially children.
                                                                                                                                Michael Hirst
         No more excuses.                                                                         President, International Diabetes Federation

4   DiabetesVoice                                                                                                                           September 2013 • Volume 58 • Special Issue 1
Children with diabetes: Protecting our future - Global perspectives on diabetes
Diabetes views

                                                 Children and
      Oft-repeated statements about
      our children, though they have
      become clichés, are nevertheless

      absolutely true. Our children are
      our future. They are our most
      precious resource. Their welfare is one
      of the few things that everyone in the
      world would agree is worth striving for.
      Politics, religions and customs still, unfortunately
      and sometimes tragically, divide us but the welfare
      of our children is one of the concerns that unites us
                                                                Our most precious resource
      – without any question whatsoever. The theme of this issue of Diabetes          Both studies are from the USA. The question of feasibility must be much
      Voice is diabetes in children and adolescents. Unless we focus on this          more marked in low-resource environments.
      theme - and act - the welfare of our children and adolescents who have
      diabetes – either type 1 or type 2 – will suffer. If we let that happen,        Another recent Diabetologia article (Lind, et al, available on-line) is the
      how will we explain our failing to them now and when they are adults?           demonstration that, at least in Canada and the UK, prospects seem to
                                                                                      be improving in terms of mortality outcomes for people with diabetes
      I was pleased to see, in a recent issue of Diabetologia, the paper by           compared with people without diabetes of the same age. Overall, the
      Persson and colleagues dealing with the impact of childhood-onset               excess mortality of people with diabetes has fallen from about twice that
      type 1 diabetes on schooling – educational achievement at the end of            of people without diabetes in 1996 to around one-and-a-half times in
      compulsory education and the end of upper secondary education – and             2009. This is still not satisfactory but it is a trend in the right direction.
      on employment status later in life. As someone who has, from time to            The authors speculate that this fall is ‘in part due to earlier detection
      time, contributed to the literature on the individual and societal costs        and higher prevalence of early diabetes, as well as to improvements in
      of diabetes, I have often thought that the ‘cost’ (in the widest sense)         diabetes care’. It’s too early to unfurl the flags and sound the trumpets yet
      of diabetes on the education of children was virtually unrecorded. In           since we need data like these from other countries but it is encouraging
      contrast, the monetary cost of diabetes to the individual and family and        to feel that the prospects for our children may be better in the future
      the cost to society of lost production of adults with diabetes have both        than they were in the past.
      been intensely studied. That study, from Sweden, found that the presence
      of diabetes had an adverse effect on children’s final grades and that those     On the last page of this issue is a new feature – Voice Box – the Diabetes
      who had diabetes as children were less likely to be ‘gainfully employed’        Voice Inbox. Your comments on our publication are invited – via
      at the age of 29. As was highlighted in a commentary on the paper in   Please keep them coming in. We are aiming for
      the same issue of the journal, the effects found were small in magnitude        this magazine to be interactive as well as active.
      but their magnitude is likely to be very dependent on the nature of the
      support given to children in any particular school system. Thus, though
      small in Sweden, the effects may be much larger elsewhere. My hunch
      would be that they are.

      The first of the selection of articles in the ‘Currently in Diabetes Research
      and Clinical Practice’ section of News in Brief in this issue is specifically
      about children. It’s a study which asks the question: do attitudes to blood
      glucose monitoring of children with type 1 diabetes have an impact on
      family harmony? The short answer is: yes, they do. Further on in this issue
      is an article, originally published in the same journal, about a different
      aspect of the same topic: to what extent are the recommendations of
      children’s care providers (i.e. diabetologists and diabetes specialist nurses
      in the main) about the frequency of self monitoring of blood glucose
      actually carried out in practice?

      Authoritative guidelines on the monitoring of blood glucose in type 1
      diabetes are demanding – four or more tests per day in most instances.
      This has a cost – financial (either to the health system or to the family,
      depending on circumstances), practical (in terms of the time and facilities
      needed to carry them out) and emotional (in terms, for example, of the
                                                                                                      Rhys Williams is Emeritus Professor of
      constant reinforcing of being ‘different’ from everyone else who don’t need
      to do this). Both studies have approached, from different perspectives, the               Clinical Epidemiology at Swansea University,
      multi-faceted question of the feasibility of adhering to these guidelines.                     UK, and Editor-in-Chief of Diabetes Voice.

September 2013 • Volume 58 • Special Issue 1                                                                                                             DiabetesVoice    5
Children with diabetes: Protecting our future - Global perspectives on diabetes
News in brief

         World Diabetes Day 2013 campaign:
         protecting our future one step at a time

         ‘Take a Step for Diabetes,’ the World Diabetes Day 2013 cam-    The 60-second PSA, produced by the IDF, promotes the
         paign, encourages people worldwide to participate directly      importance of staying healthy to help reduce complications
         in the drive for improved diabetes awareness by stepping up     associated with diabetes, such as amputation, blindness and
         or accounting for any physical or diabetes related activity.    heart disease.

         The ‘Take a Step for Diabetes’ online platform is rapidly       The PSA can be viewed at
         accumulating millions of step donations collected through
         various individual and group activities. One step equates to    How much do you know about diabetes? Are you interested
         any activity that advances awareness, improves the lives of     in helping raise awareness or becoming a diabetes advocate
         people with diabetes, promotes a healthy lifestyle or reduces   in your area? All this information and more is available in the
         the risk of developing diabetes. In recognition of the cur-     World Diabetes Day online toolkit, displayed in a user-friendly
         rent number of people living with diabetes, ‘Take a Step for    format and tailored to different target groups including the
         Diabetes’ hopes to achieve 371 million steps by the start of    general public, people with diabetes, children and youth, and
         the IDF World Diabetes Congress in Melbourne, December          health professionals.
         2013. Over 200 million steps have been submitted so far.
                                                                         The toolkit is available at
         Find out how you can take part at http://steps.worlddiabe- Every step forward is a step toward advancing
         diabetes care, prevention and a cure worldwide. Help us
         change diabetes one step at a time!

         The World Diabetes Day campaign also features a pub-
         lic service announcement (PSA) produced to inform and
         educate people about the life-threatening nature of diabetes.

6   DiabetesVoice                                                                                                 September 2013 • Volume 58 • Special Issue 1
Children with diabetes: Protecting our future - Global perspectives on diabetes
News in brief

     DAFI: Diabetes Africa Foot Initiative
      DAFI – the innovative multistakeholder          were supported by the project to attend
      Diabetes Foot Initiative in Africa – has        foot screening and care training at the
      taken a great stride forward in recent          University of Johannesburg in the middle
      weeks.                                          of July. There they participated in lectures
                                                      and workshops developed by the South              DIABETES
      The project led by IDF and its Africa
      Region, in collaboration with the
                                                      African university and Egypt’s Université
                                                      Senghor designed to lead to certification         AFRICA
      University of Johannesburg, Université
      Senghor, UNFM, Sanofi Diabetes and ten
                                                      as Diabetes Foot Care Assistants.
      healthcare centers in Africa, is now well       When they return to their centres in              INITIATIVE
      underway. Specialist training of health         Cameroon, Ghana, Guinea, Kenya,                   A project led by the International Diabetes Federation
      care professionals is on course to help         Madagascar, Republic of Congo,
      people with diabetes in ten African coun-       Rwanda, Senegal, Tanzania and Uganda,          At the same time a suite of materials has
      tries avoid the trauma of diabetic foot         the trained health care professionals will     been developed to raise awareness among
      and the risk of lower limb amputation.          use a specially developed risk stratifica-     people with diabetes living in the ten
                                                      tion and intervention tool to tackle the       selected countries about the need to care
      After an initial internal e-diabetes training   high rate of foot complications in the         for their feet to prevent complications or
      with UNFM, thirty physicians and nurses         countries.                                     existing foot problems worsening.

      Diabetes UK campaign
      for better care for children
      and young people with
      type 1 diabetes
      In early June, over 100 children and young people with
      type 1 diabetes and their families gathered at the Palace of
      Westminster in London, UK, for the parliamentary launch
      of Diabetes UK’s ‘Type 1 essentials for children and young
      people’ campaign. Diabetes UK estimates that only 6% of                Baroness Young (CEO of Diabetes UK) with Anna Soubry (MP) and young
      children and young people in the UK are getting all (‘ten              people at the parliamentary launch of the 'Type 1 essentials' campaign.

      out of ten’) of the recommended diabetes care, services and
      support that they are entitled to. These are:
      ■ Care from a specialist team                                        The campaign serves to make children’s diabetes teams aware of
      ■R  egular checks (HbA1c, weight, height etc.)                        the support that children and young people with type 1 diabetes
      ■ The right treatments                                                should be receiving and encourages the lobbying, by young
      ■ Support for self- or parental-care                                  people and their parents, of their members of parliament (MPs)
      ■ Help with feelings or worries                                       and local health care managers to ensure that these features
      ■ The right care in hospital                                         are in place in their localities. Children and their parents met
      ■ A smooth transition to adult services                              with their MPs on the day while a few families also met with
      ■ A say in the care they get                                          the Minister responsible for diabetes, Anna Soubry.
      ■ Support at school
      ■ Equal opportunities                                                 More information at:

September 2013 • Volume 58 • Special Issue 1                                                                                                      DiabetesVoice    7
Children with diabetes: Protecting our future - Global perspectives on diabetes
News in brief

in Diabetes Research
and Clinical Practice

                                                                                             On  the
    DRCP is the official journal of IDF. The following articles
    have appeared recently or are about to appear in that journal.
    Access information can be found in the QR code.

                                                                         DIABETES ABC
    Gray WN, Dolan LM, Hood KK. Diabetes Res Clin Pract
                                                                         By Dr. Sherry L Meinberg
    2013; 99: 130-5.
                                                                         Illustrated, 56 pages, Outskirts Press (November 7, 2012)
    ‘This longitudinal study examined whether diabetes-specific
                                                                         Diabetes ABC is a simple overview of diabetes and related conditions
    family conflict and glycemic control were impacted/explained
                                                                         written for both children and adults, providing tips for parents, caregivers,
    by negative affective responses to blood glucose checks.’
                                                                         friends, children and teachers about living with the illness.

    Schwarz PEH, Gallein G, Ebermann D, et al. Diabetes Res Clin         DIABETES AND ME: AN ESSENTIAL GUIDE
    Pract 2013; 100: 11-8.                                               FOR KIDS AND PARENTS
                                                                         By Kim Chaloner (Author), Nick Bertozzi (Illustrator)
    ‘The Global Diabetes Survey … is a standardised, annual, global
                                                                         Illustrated, 176 pages, Hill and Wang (November 5, 2013)
    questionnaire that will be used to assess responses of representa-
    tives from 19 diabetes-related stakeholder groups … The findings     Author Kim Chaloner was diagnosed with type 1 diabetes at age sixteen.
    will be freely available for everyone’s use and will be used to      Drawing on her own experiences, Kim walks the reader through the basics
    inform politicians and stakeholders to encourage the improve-        of type 1 and type 2 diabetes covering the latest technologies for monitoring
    ment of the quality of diabetes care in its medical, economical,     blood sugar, strategies for nutrition and exercise, how to explain diabetes
    structural and political dimensions.’                                to friends and family members and more..

    A SYSTEMATIC REVIEW                                                  By Karen M. Bolderman (Author), Nicholas B. Argento (Contributor),
    Mudaliar U, Kim W-C, Kirk K, et al. Diabetes Res Clin Pract          Susan L. Barlow (Contributor), Gary Scheiner (Contributor)
    2013; 100: 306-29.                                                   128 pages (paperback), American Diabetes Association, Second Edition
    ‘We evaluated quality of diabetes care in low- and middle-income     (September 10, 2013)
    countries (LMIC) of Central and South America … We also
                                                                         Putting Your Patients On The Pump provides practical instructions
    identified barriers to achieving goals of treatment and charac-
                                                                         for integrating all the essential elements of a safe and successful insulin
    teristics of successful programs. … Few studies report quality
                                                                         pump programme including: patient selection and education, starting
    of diabetes care in LMICs of the
                                                                         doses and fine-tuning, and long-term maintenance.
    Americas, and heterogeneity across
                                                                         Unique issues surrounding special populations such
    studies limits our understanding.
                                                                         as children and pregnancy are covered in detail. An
    Greater regard for audits, use of
                                                                         essential resource for the healthcare professional
    standardized reporting methods,
                                                                         who requires a desk reference or instructional guide.
    and an emphasis on overcoming
    barriers to care are required.’                            

8     DiabetesVoice                                                                                                          September 2013 • Volume 58 • Special Issue 1
Children with diabetes: Protecting our future - Global perspectives on diabetes
Children with diabetes: Protecting our future - Global perspectives on diabetes
My sweet
     The global campaign

          Aishath Shiruhana and Aminath Abdul Rahman

          Aminath Abdul Rahman (Aana) was born in
          1985 in Malé, the capital of the Republic of the
          Maldives Islands situated just southwest of
          Sri Lanka in the Indian Ocean. Her country’s
          national tourism campaign – 'the sunny side of
          life' – reflects the island nation’s international
          reputation as the ultimate tropical luxury for
          newlyweds in search of paradise. Consisting of
          1190 islands of which only 200 are inhabited, the
          Maldives was designated as a ‘least developed
          country’ (LDC) by the United Nations until 2011
          when it graduated to upper middle-income
          status. Prevalence of diabetes in the Maldives
          (pop. 316,000) is 9.8% and the total number of
          people living with undiagnosed diabetes hovers
          just above 8%.1

          Today, the greatest challenge faced by people
          with diabetes in the Maldives is the lack of access
          to medically necessary diabetes medications or
          supplies. Multiple injections based on basal-
          bolus therapy are impossible to administer
          because even today the only available insulin
          is long acting insulin. To make matters worse,
          insulin is only available in the capital because
          delivery to other outlying islands in the Maldives
          is too difficult. Learn about one young woman’s
          journey with type 1 diabetes in the Maldives as
          told by Aana Rahman with the help of Aishath
          Shiruhana, CEO of Diabetes Society of Maldives.

10   DiabetesVoice                                              September 2013 • Volume 58 • Special Issue 1
                                                                                                                           the global campaign

      I was diagnosed with diabetes at the          commercially available insulin in Malé,
      age of nine in 1994. Back then most           Human Mixtard 30/70, dispensed at the          Diabetes Society of Maldives (DSM)
      people living in Malé, including health-      government pharmacy. This was the only         was established in April 2000 and
      care professionals, were not aware of         insulin available if you lived with diabetes   became a member of IDF in 2002
      type 2 diabetes, let alone type 1 diabetes.   in the Maldives at the time.                   to establish greater awareness in
      Unfortunately, no one told my family                                                         the Maldives about diabetes, help
      much about my condition when I was            It took more than ten years, but things        patients lead a full and healthy life
      first diagnosed. My mom and dad did not       were going to get better for me. My            with diabetes and emphasize the
      receive any information about the basics      first experience learning about diabetes       importance of diabetes prevention.
      of diabetes from the doctors and the only     was in 2005 when I joined the Diabetes
      tertiary care hospital in Maldives did not    Society of Maldives (DSM). It was very         DSM, with a current membership
      have the necessary tests to determine         exciting and worthwhile for me because         of approximately 1200 people, is the
      whether I had developed type 1 diabetes       I was given free medical supplies, such        centre for information on diabetes
      or type 2 diabetes. Instead, I was put        as blood glucose testing kits, right after     in the Maldives and we educate the
      on type 2 oral medication based on my         I registered. I immediately got involved       community through free consulta-
                                                                                                   tions, screening programmes, and

                    Since I joined DSM, I have never                                               presentations all related to health
                                                                                                   education. This year, we had well
                  stopped learning. I know that there                                              over 100 new members join the

                  are many children like me who are                                                society and generally had about
                                                                                                   1250 follow-up appointments at the
                   grateful for diabetes assistance.                                               clinic. In addition, DSM is continu-
                                                                                                   ally working to generate awareness
      hyperglycaemic or high blood glucose          in DSM activities as a volunteer and the       and improve diabetes care through-
      symptoms and the wrong medication             Society became my second family and            out the Region. The result of this
      ultimately led to diabetic ketoacidosis       my virtual cheerleading team on the dia-       effort is best reflected in the 2012
      (DKA). Due to my constant fluctuat-           betes battlefield. Since I joined DSM, I       diabetes screening and awareness
      ing blood glucose levels and after one        have never stopped learning. I know that       programmes which found that 50%
      too many hospitalizations, I was finally      there are many children like me who            of nearly 4000 participants screened
      put on insulin therapy and told I had         are grateful for diabetes assistance from      were at high risk for developing
      type 1 diabetes. Unfortunately, the doc-      the Society. In 2008, DSM established          type 2 diabetes.
      tors had no choice but to give me the only    a programme for children living with

September 2013 • Volume 58 • Special Issue 1                                                                                     DiabetesVoice 11
The global campaign

          type 1 diabetes called ‘Save a Diabetic
          Child’. Funded by the International
          Diabetes Federation’s Life for a Child
          (LFAC) Programme and other local
          donors, ‘Save a Diabetic Child’ ensures
          that all registered children living with
          type 1 diabetes in the Maldives are pro-
          vided with insulin and testing kits.

            Campers at the
            first diabetes youth
            camp in the Region
            understood the
            important relationship
            between diabetes
            and the promise of a
            successful future.
          My relationship with DSM continued
          to thrive for a few years, but my con-
          nection to the International Diabetes
          Federation (IDF) began when I was
          given the opportunity to attend the
          first Young Leaders in Diabetes (YLD)        in the future with the support of DSM        been able to achieve my glycaemic tar-
          Programme held concurrently with the         and YLD. As a yearly programme, and          gets with my new pump!
          World Diabetes Congress in Dubai 2011.       with the help of DSM, I also established
          I was the only member representing the       a youth group for diabetes called ‘My        I am going to work hard with DSM
          South East Asian (SEA) Region and be-        Sweet Family’ which acts as an outreach      to make every effort possible to pro-
          cause of this, I was selected to be the      programme all over the Maldives.             vide insulin pumps to all children in
          SEA representative for the YLD Council.                                                   the Maldives. There is nothing more
          One of my first assigned projects was to      For so long I thought                       important than making the dreams of
          conduct a five-day diabetes youth camp        having an insulin                           children with diabetes a reality.
          for 18 children living with diabetes from     pump was an
          across the Maldives. As the first diabetes
          youth camp in SEA, the main goal of
                                                        impossible dream.
          the programme was to foster diabetes         This year, I have been selected as an
                                                                                                     Aishath Shiruhana and
          acceptance and help participants feel        organizing committee member for
                                                                                                     Aminath Abdul Rahman
          at ease in a community where having          YLD Leadership Training at the World          Aishath Shiruhana is Chief Executive
          diabetes is the rule, not the exception.     Diabetes Congress in Melbourne 2013.          Officer, Diabetes Society of Maldives.
          The campers went home feeling more           It is also an amazing year for a different    Aminath Abdul Rahman is South East Asia
                                                                                                     – Maldives representative of the IDF Young
          self-confident, and self-reliant having      reason. For so long I thought having an       Leaders in Diabetes (YLD) Programme..
          understood the important relationship        insulin pump was an impossible dream
          between diabetes self-management and         until this May when a donor selected me       References
          the promise of a successful future. I        as the recipient of my very own pump.         1. International Diabetes Federation. IDF
                                                                                                         Diabetes Atlas, 5th edn. IDF. Brussels, 2011.
          hope to facilitate more diabetes camps       I am happy to report that I have finally

12   DiabetesVoice                                                                                                               September 2013 • Volume 58 • Special Issue 1
the global campaign

                            Protecting kids' rights:
                          IDF and select partners
                        launch Kids and Diabetes
                         in Schools (KIDS) project
                                in Brazil and India
                                                                                          Anne Belton and Bénédicte Pansier

         Diabetes is increasingly becoming a more common             In June 2013, IDF, in collaboration with the International
              health threat for young people across the world,       Society for Paediatric and Adolescent Diabetes (ISPAD) and
                       demanding local communities – particularly    Sanofi Diabetes, launched the Kids and Diabetes in Schools
                      those in low- and middle-income countries –    (KIDS) project. KIDS, as a multi-stakeholder initiative,
                                                                     aims to foster a safe and supportive school environment
              execute measures that will ensure young people
                                                                     for children with diabetes to manage their diabetes and
                with diabetes can live equally rich and fulfilling
                                                                     fight discrimination. The fundamental rights of children
                lives as their peers. In collaboration with select
                                                                     living with diabetes include the freedom to access care and
       partners, the International Diabetes Federation has           support to manage diabetes appropriately and to be fully
          developed a project designed to support children’s         included and engaged in all school activities to achieve
        rights, ensuring school days are happy days for the          their full potential. KIDS also aims to raise awareness of
               diagnosed, and encouraging healthy behaviours         diabetes and promote healthy diet and exercise habits in
                         among all school-aged children worldwide.   the school community.

September 2013 • Volume 58 • Special Issue 1                                                                            DiabetesVoice 13
The global campaign

                                                                          At the end of the first phase of the project (18 months), a Global
                                                                          Diabetes in Schools Toolkit will be developed and made avail-
                                                                          able to IDF Member Associations to roll out the project, after
                                                                          the pilot launch, in other successive parts of the world. In the
                                                                          second phase, KIDS aims to achieve government support for
                                                                          systemic change for children with diabetes in schools including
                                                                          dissemination of national guidelines.

                                                                          Global threat of childhood diabetes
                                                                          Type 1 diabetes is one of the most common chronic child-
                                                                          hood diseases, affecting an estimated 490,000 children under
                                                                          15 years. The incidence of type 1 diabetes among children
                                                                          is increasing in many countries and approximately 78,000
                                                                          children under 15 years are estimated to develop type 1
                                                                          diabetes annually worldwide.1-3

                                                                           Type 2 diabetes in childhood
                                                                           has the potential to become a
                                                                           global public health issue.
                                                                          Young people today also face another danger that threatens
                                                                          their ability to attain a healthy and successful future. Evidence
                                                                          shows that type 2 diabetes is also increasing in children and
                                                                          adolescents around the world at alarming rates. With rising
                                                                          levels of childhood obesity and physical inactivity in many
                                                                          countries, type 2 diabetes in childhood has the potential to
                                                                          become a global public health issue.4-6

                                                                          Against this backdrop, the school system is a vitally important
                                                                          environment for children with diabetes, especially as it relates
                                                                          to day-to-day self-management care and total well-being.
                                                                          Schools perform a critical role supporting and educating
                                                                          children with diabetes so they have the same opportunities
          Implementing and integrating KIDS into school communities       afforded other children, such as participating in the classroom
          successfully requires serious commitment from policy makers     or playground.
          and education authorities; completion of situational analyses
          summarizing opportunities and challenges; execution of a        IDF leadership for childhood diabetes
          fully-fledged school awareness campaign; and development        In March 2005, IDF released a position statement on the
          and introduction                                                                                        Rights of the Child in
          of a diabetes school                                                                                    the School declaring
          information pack
          and teacher training
                                   KIDS aims to achieve government                                                that children have
                                                                                                                  the right to man-
          for selected coun-        support for systemic change for                                               age their diabetes
          tries. IDF’s Young
          Leaders in Diabetes
                                   children with diabetes in schools.                                             without being ex-
                                                                                                                  cluded or discrimi-
          Programme will lend                                                                                     nated against7 in the
          support and help disseminate the KIDS packs when the project    school setting. The Position Statement calls for all children
          kick-starts in Brazil and India, our two pilot countries.       with diabetes to have an individualized diabetes plan devel-

14   DiabetesVoice                                                                                                   September 2013 • Volume 58 • Special Issue 1
the global campaign

      oped in a collaborative approach with healthcare providers,
                                                                          Anne Belton and Bénédicte Pansier
      school staff and the family.
                                                                          Anne Belton is a Diabetes Nurse Educator and Education Consultant.
                                                                          She has been a member of the Federation's Consultative Section
      Numerous guidelines and educational materials on diabetes in        on Education since 2000 and is a Vice-President of the International
                                                                          Diabetes Federation for 2013-15.
      schools for teachers, parents and children have been made avail-    Bénédicte Pansier is Account Manager, International Diabetes Federation.
      able in several countries.8-11 Effective campaigns about diabetes
      management in schools include the Australian Diabetes Council’s
      ‘Diabetes kidsandteens Careline’ (2006), the American Diabetes
      Association’s ‘Safe at School’ Campaign (2011), Diabetes UK
      Children's Campaign ‘Let's Talk Type 1 Diabetes in Schools’
                                                                          1. International Diabetes Federation. IDF Diabetes Atlas, 5th edn. IDF. Brussels, 2011.
      (2011), the IDF and its Italian Member Association's ‘Good
      Diabetes Control’ campaign for schools (2012/2013) and the          2. Diamond Project Group. Incidence and trends of childhood type 1 diabetes
      Diabetes Program at Schools in Turkey (2012).12                         worldwide 1990-1999. Diabet Med 2006; 23: 857-66.

                                                                          3. Patterson CC, Gyürüs E, Rosenbauer J, et al. Trends in childhood type 1 diabetes
      Despite this work, evidence suggests that many children                 incidence in Europe during 1989–2008: evidence of non-uniformity over time
                                                                              in rates of increase. Diabetologia 2012; 55: 2142-47.
      and adolescents with diabetes continue to face barriers
      to education and endure discrimination and stigma, in               4. Alberti G, Zimmet P, Shaw J, et al. Type 2 diabetes in the young: the evolving
      particular in low- and middle-income countries. School                  epidemic: the International Diabetes Federation consensus workshop.
                                                                              Diabetes Care 2004; 27: 1798-811.
      and national policies don’t often recognize the special
      needs of a child living with diabetes. Lack of the assistance       5. Chiarelli F, Marcovecchio ML. Insulin resistance and obesity in childhood.
                                                                              Eur J Endocrinol 2008; 159: 67-74.
      needed to monitor blood glucose, administer insulin and
      treat emergency situations (e.g. hypoglycaemia) can result          6. Rosenbloom AL, Silverstein JH, Amemiya S, et al. Type 2 diabetes in children
      in the child being excluded from school activities. Some                and adolescents. Pediatr Diabetes 2009; 10: 17-32.

      schools believe they reserve the right to deny access to a          7. International Diabetes Federation. IDF Position Statement: The Rights
      child with diabetes and even when allowed to matriculate,               of the Child with Diabetes in the School. IDF. Brussels, 2005.

      some children are barred from participating in extracur-
                                                                          8. American Diabetes Association. Diabetes care in the school and day care setting.
      ricular activities.13-16 Ignorance and misconceptions about             Diabetes Care 2012; 35: S76-80.
      diabetes held and fostered by school personnel, fellow
                                                                          9. Evert AB, Hanson JH, Hood KK, et al. AADE Position Statement Management
      students and parents of other students are often at the root            of children with diabetes in the school setting. Diabetes Educ 2008; 34: 439-43.
      of such stigma and discrimination. Furthermore, a school
                                                                          10. National Diabetes Education Program. Helping the Student with Diabetes
      classroom may not provide clean and adequate space to sup-
                                                                               Succeed: A Guide for School Personnel. NDEP. Washington DC, 2010.
      port self-management tasks such as testing blood glucose,
      storing snacks, injecting insulin or storing equipment for          11. Diabetes UK. Children with Type 1 Diabetes at School. What All Staff Need to Know.
                                                                               Diabetes UK. London, 2005.
      injections or lancets for blood glucose testing.
                                                                          12. Şükrü Hatun. Diabetes program at schools in Turkey. J Clin Res Pediatr Endocrinol
                                                                               2012; 4:114-5.
      Endpoints of KIDS - Phase 1
      The IDF KIDS project will begin with a feasibility study            13. Amillategui B, Calle JR, Alvarez MA, et al. Identifying the special needs of
      supported by two local implementing partners, the IDF                    children with type 1 diabetes in the school setting. An overview of parents'
                                                                               perceptions. Diabet Med. 2007; 24: 1073-9.
      Member Association Associação de Diabetes Juvenil (ADJ)
      in Brazil and the Public Health Foundation of India (PHFI).         14. Olympia RP, Wan E, Avner JR. The preparedness of schools to respond to
                                                                               emergencies in children: a national survey of school nurses. Pediatrics 2005;
      This feasibility study will identify and engage with relevant
                                                                               116: 38-45.
      stakeholders at national, regional and
      local levels, review existing guide-                                15. Hellems MA, Clarke WL. Safe at school: a Virginia experience. Diabetes Care
                                                                               2007; 30: 1396-8.
      lines and initiatives on diabetes
      in the school environment and                                       16. Pinelli L, Zaffani S, Cappa M, et al. The ALBA Project: an evaluation of needs,
                                                                               management, fears of Italian young patients with type 1 diabetes in a school
      carry out a needs assessment in
                                                                               `setting and an evaluation of parents' and teachers' perceptions. Pediatr Diabetes.
      the two countries. The results are                                       2011; 12: 485-93.
      expected by September 2013.

September 2013 • Volume 58 • Special Issue 1                                                                                                             DiabetesVoice 15
The global campaign

          A look 'upstream' to Melbourne
          In the spirit of patient
          Angus Forbes

          Are the latest treatment innovations     The Education and Integrated Care
          enough for people living with diabe-     Stream scheduled for the IDF World
          tes in the 21st century? How can the     Diabetes Congress in Melbourne will
          medical profession utilise current       address global perspectives on key di-
          technologies and treatment inno-         lemmas associated with diabetes self-
                                                   management innovations in the 21st
          vations without losing touch with
                                                   century. Today’s advances in diabetes
          patient values and the power of com-
                                                   medical therapies continue to expand
          passion and insight?
                                                   opportunities for improving treatment
                                                   and management strategies. However,
          Leading the way for the Education        advanced treatments are only effective
          and Integrated Care Stream, Angus        if people with diabetes can use them
          Forbes allows us to ‘shadow’ the         appropriately and accommodate them
          exciting programme planned for           within their daily lives.1 There is also
          Melbourne 2013. Care integration         growing recognition within the diabe-
          and patient-centeredness will be         tes community that an individualised
          threaded throughout lectures, dis-       approach to diabetes care2 may lead
          cussions and symposia with renewed       to enhanced adherence to therapy.
          energy and insight. To reflect the im-   Individualised programmes should
          portance of empowerment, people          identify more than just individual risk
                                                   assessment, and actively involve peo-
          living with diabetes will be actively
                                                   ple with diabetes in identifying their
          participating in forums and discus-
                                                   own targets and treatment decisions.3
          sions alongside healthcare provid-
                                                   Consequently the value of diabetes
          ers. Switching to a broader perspec-
                                                   innovations, especially those designed
          tive, global variations in innovation,   to motivate people and reinforce posi-
          education and self-management            tive self-management behaviours, is
          care will be reviewed, helping to        directly linked to improved outcomes
          address the need for a worldwide         making them essential for advancing
          diabetes care reality check.             diabetes care.

16   DiabetesVoice                                                                            September 2013 • Volume 58 • Special Issue 1
the global campaign

      Care integration has been a key buzzword       health models; the interface between the   a reality for people living with diabe-
      in the healthcare landscape for the last       person with diabetes and family mem-       tes? To answer this question, we will be
      decade. Currently identified as one of the     bers; and innovative approaches to inte-   sharing key multinational data that may
      most important qualities for the develop-      grating care systems.                      reveal whether patient values actually
      ment of effective care systems in diabetes,                                               guide clinical decisions. In the spirit of
      integration is a professional healthcare        Advanced treatments                       patient centeredness, we will facilitate
      preoccupation because the collective ap-        are only effective if                     discussions and ask people living with
      proach of providing patient-centred care,       people with diabetes                      diabetes about current trends in patient
      quality, safety and efficiency all in one is                                              education. We will also examine alterna-
      demanding. Care integration is an over-
                                                      can use them                              tive techniques for engaging patients in
      arching theme embedded throughout the           appropriately and                         their care, including the use of narrative
      Stream, and we will examine important           accommodate them                          medicine and through media such as art
      areas where integration is challenging,                                                   and storytelling. We are privileged that
                                                      within their daily lives.
      especially for mental health and diabetes;                                                one of the leading advocates of a patient
      transitions across the ages and in the         Is person centeredness, regarded as a      centred approach to diabetes educa-
      context of gender; integrating alternative     central tenant of modern diabetes care,    tion, Professor Jean-Philippe Assal, will

September 2013 • Volume 58 • Special Issue 1                                                                                     DiabetesVoice 17
The global campaign

                                                                                                      controversial topics such as current
                                                                                                      dietary trends (weeding out the fads)
                                                                                                      and scrutiny related to extreme levels of
                                                                                                      exercise. Opportunities for participants
                                                                                                      to interact with these important topics
                                                                                                      through interactive discussions and in
                                                                                                      workshops will be provided.

                                                                                                       Angus Forbes
                                                                                                       Angus Forbes is FEND Professor of
                                                                                                       Clinical Diabetes Nursing at King’s College
                                                                                                       London, UK. He leads the Education and
                                                                                                       Integrated Care Stream at the IDF World
                                                                                                       Diabetes Congress in Melbourne, 2013.

          present a lecture entitled, ‘Power and          potential for greater self-management
          fragility in health, illness and disease: the   support is enhanced.
          role of healthcare providers and patients’
          as part of the Melbourne programme.             There will be a symposium on the chal-
                                                          lenging area of type 2 diabetes preven-
            Is person centeredness,                       tion in young people. Clearly with ris-
            regarded as a central                         ing childhood obesity levels there is an
                                                          urgent need to develop effective strate-     References
            tenant of modern                              gies to help young people become more        1. Odegard PS, Capoccia K. Medication taking
            diabetes care, a                              active and consume less highly refined           and diabetes: a systematic review of the
                                                                                                           literature. Diabetes Educ 2007; 33: 1014-29.
            reality for people                            carbohydrate.5 We will be exploring this
            living with diabetes?                         from a number of perspectives, includ-       2. Inzucchi SE, Bergenstal RM, Buse JB, et al.
                                                          ing innovative work on the use of play to        Management of hyperglycemia in type 2 diabetes:
                                                                                                           a patient-centered approach: position statement
          Additionally, we will consider the              increase activity and through integrated         of the American Diabetes Association (ADA)
          important area of adherence, which              programmes targeting schools, families           and the European Association for the Study of
                                                                                                           Diabetes (EASD). Diabetes Care 2012; 35: 1364-79.
          we know is a significant predictor of           and the environment.
          diabetes complications.4 Many factors                                                        3. N
                                                                                                           ational Institute for Clinical Excellence (NICE).
          contribute to adherence, and the pro-           Finally, reflecting the global nature of        Type 2 Diabetes: the Management of Type 2
          gramme will highlight some current in-          the Congress, we will have presenta-            Diabetes. Clinical guideline; no. 87. NICE.
                                                                                                          London, 2009.
          novations in this area including sessions       tions from different regions, highlight-
          on the potential of asking more from            ing innovative strategies from all over      4. Donnelly LA, Morris AD, Evans JMM, et
          patients in the development of therapies;       the world. Presentations from low- and           al. Adherence to insulin and its association
                                                                                                           with glycaemic control in patients with
          quality use of medicines; and how in-           middle-income countries (LMICs) will             type 2 diabetes. QJM 2007; 100: 345-50.
          novations actually enhance adherence.           examine how innovative education pro-
          E-health technologies are evolving rap-         grammes are often executed with limit-       5. World Health Organization (WHO).
                                                                                                           Childhood overweight and obesity. http://www.
          idly in tandem with the changing way            ed resources. We will also explore global
          people communicate and interact more            variations in access to psychological and
          generally. In addition to the use of social     self-management care with a special          6. Peyrot M, Burns KK, Davies M, et al.
                                                                                                           Diabetes Attitudes Wishes and Needs
          media and mobile health (m-health)              symposium from the DAWN 2 Study.6
                                                                                                           2 (DAWN 2): A multinational, multi-
          interventions, we will discuss how new          The programme will showcase current              stakeholder study of psychosocial issues in
          technologies can be integrated within           trends in diabetes education worldwide.          diabetes and person-centred diabetes care.
                                                                                                           Diabetes Res Clin Pract 2013; 99: 174-84.
          the wider care system and how the               There will also be special sessions on

18   DiabetesVoice                                                                                                               September 2013 • Volume 58 • Special Issue 1
the global campaign

                                               A look 'upstream' to Melbourne

                                               diabetes on the
                                                global agenda
                                                                                                               Linong Ji

                                                                                The Stream will provide a comprehen-
            The global impact of diabetes in the 21st century has been          sive look at the global challenges facing
            compared to the after-effects of a tsunami: diabetes threatens      diabetes care and treatment today and
                                                                                ask the big questions relating to diabetes
            the future of many millions and crushes the stability of national
                                                                                and global health. How can we create
            health and economic systems. Climate change, globalisation,         national diabetes plans which will be
            urbanisation, changing demographics and economic shifts are         helpful not only to people with diabetes
            all part of the bigger global picture in which diabetes plays       but also to people at risk? What should
                                                                                the role of WHO and other international
            an increasingly dominant role.
                                                                                organisations be in creating these plans?
                                                                                What is the impact of globalisation and
            Professor Linong Ji, lead for the Global Challenges in Health       urbanisation on diabetes and how can we
            Stream, introduces the upcoming Melbourne programme,                mitigate their negative effects? Speakers
            explaining the obligation of all sectors to prioritise diabetes.    from all over the world will identify what
                                                                                works both locally and globally in terms
            Invited experts will examine what we must do to frame diabetes
                                                                                of combatting the epidemic and what still
            within the larger public health context and secure a healthier      needs to be done. Our objective should
            future for everyone, irrespective of their geographic location.     be to foster real change for people with
                                                                                diabetes and those at risk.

September 2013 • Volume 58 • Special Issue 1                                                                     DiabetesVoice 19
The global campaign

          Advocating change                             the first time. As the age of populations     We hope you will join us for our sessions
          IDF in cooperation with the NCD               increase, so does the overall risk for de-    because this really is about you! I look
          Alliance has been at the forefront of glob-   veloping type 2 diabetes. The increasing      forward to seeing you in Melbourne
          al health advocacy, working to position       number of co-morbidities in an ageing         and joining together to shape the future
          diabetes and other Non-communicable           population also complicates treating          of diabetes.
          Diseases (NCDs) on the global health          diabetes in this population. Stream ses-
          agenda and the post-2015 development          sions dedicated to ageing will focus on
          agenda. In 2012, the World Health             our health systems and whether or not
          Assembly took a crucial step in acknowl-      they are ready to deal with the impact of
          edging the problem by setting a target to     rapidly changing demographics.
          reduce preventable NCD deaths 25% by
          2025. Experts in the Global Challenges        From global to local
          in Health Stream will consider this target    Unless we can make an impact on the
          alongside the historic target to ‘halt the    lives of people with diabetes in the ‘real
          rise in diabetes,’ with a constructively      world,’ discussion and debate on research
                                                                                                       Linong Ji
          critical eye. Are the WHO targets hype        outcomes will fall short of making a
                                                                                                       Linong Ji leads the Global Challenges in
          or hope? How do we achieve them in            real difference. The Global Challenges         Health Stream at the IDF World Diabetes
          low-and middle-income countries?              in Health Stream will therefore focus a        Congress in Melbourne, 2013. He is a
                                                                                                       Professor of Medicine, Director of the
                                                        large part of its attention on how we can      Department of Endocrinology and
          An ageing society and its accompany-          translate research to real world settings.     Metabolism at Peking University People’s
                                                                                                       Hospital and Co-Director of Diabetes
          ing challenges to public health will be       Unified, we can fight the epidemic on          Centre of Peking University. He is the
          another essential focus of the Stream.        the diabetes battlefield, where the disease    recent President of the Chinese Diabetes
                                                                                                       Society and a Vice-President of the
          In 2030, the number of people over 60         continues to claim so many lives in com-       International Diabetes Federation.
          will outnumber those under fifteen for        munities and societies.

20   DiabetesVoice                                                                                                         September 2013 • Volume 58 • Special Issue 1
the global campaign

                                       National programme
                                                  in Turkey:
                                        Diabetes at School
                                                                                                 Şükrü Hatun and Şeyda Özcan

            In 2010, Turkey’s Diabetes         All school children with diabetes de-       recent study, upon returning to school,
                Program at School was          serve the same educational opportuni-       the HbA1c of children with type 1 dia-
         developed as a joint protocol         ties as their healthy peers. Teachers and   betes increased and they had problems
                                               school staff have the responsibility to     with their diabetes care. Some children
                initiated by the Turkish
                                               create an equal opportunity learning        with type 1 diabetes are forbidden to
                   Society of Paediatric
                                               environment for all children, including     participate in physical education and
       Endocrinology and Diabetes in           those with diabetes. Educating teach-       some activities such as school trips
        cooperation with the Ministry          ers about diabetes and organizing the       are off limits. It has been reported that
             of Education and Ministry         school environment for better diabetes      some infant nurseries and kindergartens
           of Health. Objectives of the        care will reduce the problems faced by      refuse registering children diagnosed
         programme targeted school             children with diabetes in school and        with diabetes to avoid the respon-
                                               improve their quality of life. Providing    sibility of care. Children with type 1
          communities across Turkey
                                               diabetes awareness in the school en-        diabetes are sometimes labelled as sick
          in order to raise awareness
                                               vironment may also assist with early        and are viewed as abnormal due to lit-
       about type 1 diabetes, provide          detection and diagnosis.                    tle awareness or facts about diabetes.
            better diabetes paediatric                                                     On the contrary, children with diabe-
             care, improve nutritional         Children and diabetes in Turkish            tes should not only be allowed access,
        standards for school children          schools: eliminating the avoidance          but also motivated to participate in all
           and prevent obesity. In just        of care                                     activities with their schoolmates. To
      two years, a number of trained           There are approximately 20,000 chil-        accommodate students with diabetes,
                                               dren, mostly of school age, living with     a school nurse or a counsellor should
        teachers detected symptoms
                                               diabetes (mostly type 1) in Turkey.         be trained on basic diabetes care. Other
       of diabetes in 40 undiagnosed
                                               Unfortunately, many children living         diabetes care requirements may include
            children. Şükrü Hatun and          with type 1 diabetes and their families     a private space for measuring blood
             Şeyda Özcan explain why           encounter problems in accessing the         glucose and injecting insulin as well as
             and how they achieved so          school environment and participating        the provision of healthy school meals,
                  much in so little time.      in school programmes. According to a        refreshments and toilet breaks during

September 2013 • Volume 58 • Special Issue 1                                                                               DiabetesVoice 21
The global campaign

                                                          classes. Moreover, teachers should learn    and Ministry of Health. Target groups
                                                          the signs of diabetes and be able to rec-   of the Diabetes Program at School in-
                                                          ognize symptomatic children earlier in      clude all professional teachers across
                                                          order to avoid serious events such as       Turkey, teachers who currently oversee
                                                          diabetic ketoacidosis.                      the education of children with diabe-
                                                                                                      tes, members of the paediatric diabetes
                                                           One third of children                      medical team, local representatives of
                                                           have also developed                        the Ministry of Education and Ministry
                                                                                                      of Health and school administrators.
                                                           an increased risk for
                                                           adulthood obesity and/                     The objectives of the programme are to:
            Soner Aydın, 13 years old,                     or type 2 diabetes.                        ■ Raise school community and teacher
            was diagnosed with type 1                                                                    awareness about type 1 diabetes
            diabetes because his teacher                  The diabetes care and detection concern       ▶ ensure early diagnosis of type 1 dia-
            was aware of his symptoms.                    in schools becomes even more complex             betes and decrease the frequency of
                                                          with the growing problem of weight-              diabetic ketoacidosis among school
                                                          gain and obesity in childhood. Obesity           children.
            Soner Aydın, 13-years-old, is an 8th grade
            student at Mehmet Soykan Primary
                                                          frequency among the age group of six        ■ Provide better care for children with
            School in Sakarya’s Akyazı Kuzuluk            to sixteen years has increased from 5%         diabetes
            Village.                                      to 10.5% (16.3% among high income           ■ Create a healthy nutrition attitude
                                                          level group) in the last eight years in        among school children
            In December 2012, Soner was diagnosed         Turkey. One third of children have also     ■ Raise awareness about obesity
            with type 1 diabetes at the Kocaeli Medical   developed an increased risk for adult-
            School Pediatric Service. Soner went to       hood obesity and/or type 2 diabetes.        Diabetes Program at School materials
            the hospital with his story about drinking    Childhood obesity is caused primar-         and activities
            excessive amounts of water, waking up at      ily by poor lifestyle habits including      The Diabetes Program at School, offi-
            night to urinate, having to frequently ‘lay   the consumption of high-calorie or          cially initiated on November 12th, 2010 in
            his head on the desk’ due to fatigue in
                                                          processed junk food such as sugar-          Istanbul, succeeded in drawing together
            the classroom and constantly asking his
                                                          sweetened beverages, and physical           a large group of teachers and securing
            teacher for bathroom breaks during class.
                                                          inactivity. Preventing obesity in adult-    broad coverage from the national press.
            Soner’s science teacher, Deniz Göktepe,
            directed him to the hospital because she
                                                          hood depends mainly on the efforts in       Each of the teachers who participated in
            had grown suspicious of his situation in      childhood and around puberty. In re-        the national meeting went on to organise
            school. Deniz weighed the available in-       cent years, the government has directed     diabetes meetings in schools with the
            formation and warned her student he           more attention to childhood nutrition,      assistance of local authorities. In 2011, a
            might have diabetes, suggesting he have       and the Radio and Television Supreme        one-day training meeting was organised
            his blood sugar checked only to find out      Council (RTÜK) has limited advertise-       across Turkey, which included teach-
            Soner’s blood sugar was 384 mg/dl. Deniz      ments that promote high-calorie food.       ers, government officials, and paediatric
            relayed to those that thanked her that she    Turkey’s Ministry of Education has also     diabetes and obesity experts. By World
            had been informed because she attended        restricted sales of junk food and sugar-    Diabetes Day 2011, the entire campaign
            the educational seminar organized by          sweetened beverages at schools.             was launched and millions of school
            the Diabetes at School programme. She
                                                                                                      children and teachers joined the school
            added that diabetes was a condition famil-
                                                          Aim of Diabetes Program at School           training sessions that were organised
            iar to her family, how the latest seminar
                                                          The Diabetes Program at School was          within the scope of the programme and
            had helped her realize that Soner might
            have developed diabetes, and would also
                                                          developed as a joint protocol initiated     facilitated by diabetes health experts.
            inspire her to prepare a meeting about        by the Diabetes Working Group embod-
            diabetes in her school and become per-        ied in the Turkish Society of Paediatric    Awareness was further reinforced with a
            sonally involved with Soner’s case.           Endocrinology and Diabetes in coop-         poster campaign, entitled, ‘Does my child
                                                          eration with the Ministry of Education      have diabetes?’ and distributed to 60,000

22   DiabetesVoice                                                                                                        September 2013 • Volume 58 • Special Issue 1
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