Over 1 million children and adolescents under the age of 20 are living with type 1 diabetes (1). Type 2 diabetes is also increasingly prevalent in childhood and has the potential to become a global public health issue, due to increasing levels of overweight and obesity, driven by physical inactivity and unhealthy diets (2).
The school environment helps shape a child’s education and behaviours. It therefore has an important role to play in raising diabetes awareness and promoting physical activity and healthy diets to tackle the rising prevalence of type 2 diabetes (3).
COVID-19 has given this role further emphasis. Despite the lack of data on the long-term impact of the pandemic on children and youth, current research indicates that it may have worsened existing insufficient levels of physical activity among children and adolescents, due to prolonged school closures and home confinement (4-11). Recreational screen time and the consumption of sugar-sweetened beverages also appear to have increased along with rates of food insecurity in children (5-12,6-13,7-14). These are linked to a higher risk of weight gain and obesity (8-15).
For many children living with diabetes and their families, lack of diabetes awareness is the primary issue they face in the school environment. Management of type 1 diabetes involves daily insulin injections, regular blood glucose self-monitoring and the adoption of a healthy lifestyle. This can be challenging and cause emotional and physical distress at all ages – particularly in children and adolescents. Multiple daily injections, for example, can be perceived negatively by people who do not have a good understanding of diabetes. This can lead to discrimination and stigma, which has been linked to decreased school attendance and can have a life-long impact on a child’s education and future growth (9).
The special needs of children living with diabetes are often not recognised by school and national policies. Many schools do not provide adequate and clean spaces to support diabetes self-management tasks and the storage of insulin delivery equipment (10). This can result in a child’s exclusion from sports and social activities (11).
Children with diabetes are not alone in being impacted. Teachers and other school staff often feel uncomfortable when confronted with pupils living with diabetes. They do not receive sufficient practical training, with many countries not having the resources to develop an effective education programme for teachers and other school staff.
The KiDS project
In response, the International Diabetes Federation (IDF), the International Society for Paediatric and Adolescent Diabetes (ISPAD) and Sanofi launched the Kids and Diabetes in Schools (KiDS) project in 2013. KiDS aims to tackle diabetes-related stigma by fostering a safe and supportive school environment for children with diabetes, and promoting healthy habits to address the risk factors for type 2 diabetes.
The primary targets are school students (6-14 years), teachers and other school staff (e.g. school nurses) and parents. Government and education authorities are also among the main audiences, as the KiDS project ultimately aims to encourage the development and implementation of national policies around diabetes education and healthy habits.
The KiDS project is delivered through sessions and trainings organised in collaboration with school communities. In the first phase of the project, a Diabetes Information Pack was developed by an international multidisciplinary committee of experts. This was piloted in two countries – Brazil and India – where it engaged 1,393 school staff and 38,000 students with the support of local partners, the Associação de Diabetes Juvenil (ADJ) and the Public Health Foundation of India (PHFI).
A qualitative evaluation study of the pilot implementation revealed that KiDS was successful in improving diabetes knowledge and raising awareness of the importance of including children with diabetes in general school curricular activities (12,13).
The KiDS Diabetes Information Pack has subsequently been made available in 18 languages to facilitate implementation across the world.
There are currently two implementation models for the project:
- Structured – consecutive sessions and educational events supported by policy makers, local NGOs and other partners. This model has been implemented in 9 countries.
- Ad-hoc sessions – KiDS project resources adapted for inclusion within existing school health education programmes. This model has been applied in over 45 countries.
Since its inception, the KiDS project has engaged 1,790 schools, 18,700 teachers and school staff, and 248,000 children through the structured sessions in ten countries.
Recent years have seen the development of additional KiDS resources to complement the Diabetes Information Pack. These include an Educational Guide on Nutrition and Diabetes in Schools and an interactive online quiz on healthy nutrition – NutriQuiz. Both target school teachers, other school staff, parents and primary school children and promote the importance of nutrition and balanced lifestyles in the management and prevention of diabetes. They are aligned with World Health Organization recommendations and the pedagogical methodology of “learning-by-playing” (14).
A KiDS Advocacy Toolkit is now available to help advocates influence local or national decision-makers to bring diabetes education into schools. This and all KiDS resources can be freely accessed at kids.idf.org.
Case study: Podkarpackie, Poland
In 2018, the KiDS project was successfully implemented in the Podkarpackie region of Poland. Over half of residents in this region are overweight and it is home to one of the highest populations of children and adolescents with type 1 diabetes in Europe (15,16).
The KiDS project was implemented in 15 primary schools and engaged 1,373 children (aged 6-14) and 40 teachers, helping to create a supportive school environment for children with diabetes and increase diabetes awareness among the general student population and staff. In addition, 250 medical students from the Medical Faculty of the University of Rzeszów were trained to deliver diabetes education in the selected schools.
The implementation was a success thanks to the involvement and support of multiple stakeholders. These included the Ministry of Education, the Mayor of Rzeszów, the Podkarpackie School Inspector and Regional Sanitary Inspector, and local affiliates of the Polish Diabetes Association and Polish Federation of Education in Diabetology.
In recognition of its achievements, the implementation of the KiDS project in the Podkarpackie region received the 2018 European Federation of Pharmaceutical Industries and Associations (EFPIA) Health Collaboration Award in the Prevention & Awareness Category (10).
