The prevalence of Type 1 Diabetes in Texas children is estimated at between 1 in 400 and 1 in 500 children. This would predict that about 188 AISD students have Type 1 Diabetes. In SY 2013-14, 79 students were case managed by RNs for Type 1 Diabetes. The nurses’ acuity survey indicates 169 diabetic students. Older students who successfully self-manage their condition may not receive case management if they choose not to receive it; however, the school RN is always available if needed. Students with this condition generate a large number of time-intensive health contacts to monitor and manage blood glucose levels daily in the school setting. SHS staff report blood glucose levels to nurse managers according to protocol. Nursing managers guide decisions related to the individualized care plans, given glucose levels. They work closely with Dell Children’s Medical Center pediatric endocrinologists and the SHS Medical Director to insure proper care for students.
Obesity is the major risk factor for Diabetes Type 2. Texas Youth Risk Behavior Survey data for 2011 indicate that 15.6% of Texas high school students describe themselves as obese (BMI>95%ile) and 16% describe themselves as overweight (BMI >85%ile, <95%ile). The Texas Department of State Health Services estimates that based on measures of body mass index (BMI), approximately 22% of Texas children are overweight, and an additional 15% are obese (37% high BMI). Although Type 2 diabetes is found in all ethnic groups, a disproportionate number of African American, Hispanic and American Indian persons are diagnosed. Children who are diagnosed with Type 2 diabetes are typically overweight/obese.
Type 2 Diabetes Vulnerability Screening
The Texas legislature has mandated that school nurses screen students for Type 2 Diabetes vulnerability based on acanthosis nigricans (AN), a skin discoloration associated with insulin resistance. Students with the skin discoloration receive additional health assessments such as body mass index and blood pressure. Those students with a grade 4 skin discoloration or the discoloration in combination with another factor such as elevated blood pressure are referred for medical follow-up. During School Year 2013-14, of the 25,617 students in grades 1,3, 5, and 7 screened, 1370 (5.3%) were referred to health providers. For more information on AN please refer to the state legislative report. Children with overweight and obesity are also at risk for additional current and future medical problems. Children with overweight/obesity are identified through the Fitnessgram’s BMI assessment.This measure indicates 34,000 AISD students are challenged by overweight or obesity.
Based on findings returned from medical providers, only 4.4% of students referred to a medical provider are found to be within normal limits, 59.3% of the students referred are found to be obese, and 18.6% are found to be vulnerable for type 2 diabetes.
Student Fitnessgram data has been integrated into the student’s health record via the Student Health Information System (SHIS). School nurses now have access to the student’s BMI measures. As AISD transitions from their own Fitnesstracking program to a web-based tool through Human Kinetics, the data integration with SHIS will need to be revisited.
A multiyear increasing trend in diabetic health contacts is evident.