School-Based Health Equity Initiative Improves T1D Management in Students

School-Based Health Equity Initiative Improves T1D Management in Students 1024 683 JoAnna Pendergrass, DVM

The Diabetes and School Health program is a school-based health equity initiative that has helped improve Type 1 diabetes management for students and increase confidence among school staff and caregivers in providing diabetes care.

Children with Type 1 diabetes (T1D) face myriad daily challenges in managing their disease, which can be compounded if their home and school environments cannot provide the support and resources for optimal disease management.

Suboptimal T1D management, whether at home or school, contributes to complications like disrupted sleep, decreased school performance and medical complications such as renal and cardiovascular disease.

“Unfortunately, no standardized guidelines exist for in-school TID management, highlighting a national problem,” says Kajal Gandhi, DO, MPH, a pediatric endocrinologist at Nationwide Children’s Hospital.

In 2021, Dr. Gandhi and her team launched the Diabetes and School Health (DASH) program to provide seamless and effective diabetes management for students in central Ohio most at risk for T1D complications.

Since then, the program’s students, families, and school nurses have benefitted from collaborative work to provide optimal T1D care.

Dr. Gandhi and her team presented their findings at the 2023 International Society for Pediatric and Adolescent Diabetes conference in Rotterdam, The Netherlands.


DASH Details

DASH is a community-based initiative coordinating diabetes care between schools and Nationwide Children’s. The program’s goals fall into three main categories:

  • Streamline patient care
  • Provide ongoing support/communication
  • Enhance education and advocacy for students, families and school staff

The program enrolled 40 to 50 students in its pilot year and currently enrolls over 100 students. Dr. Gandhi notes that enrollment fluctuates due to factors like transitioning to homeschooling.

The pilot students were 5 to 18 years old, and nearly 70% self-identified as ethnic minorities. The researchers collected objective data on diabetes care: hemoglobin A1C, Diabetes Composite Score, use of diabetes technology and acute care utilization.

Students completed assessments related to their skill and mastery of diabetes care. Parents assessed their child’s skills and perspectives with diabetes care, and school nurses assessed their comfort and confidence with managing T1D in the school setting.


Key Takeaways

The researchers have observed many program achievements. For example, “We increased the number of students on diabetes technology, and that number has continued to increase,” said Dr. Gandhi.

Among the enrolled students, there was also an improved median A1C, an increase in Diabetes Composite Score and an increased number of medical T1D visits as recommended by national diabetes guidelines.

Dr. Gandhi highlighted that the program improved care coordination with the school and NCH diabetes team. “Challenges with diabetes care, including disease management and home environment, may not be revealed in a short doctor visit. Rapport and collaborative care provide a 360-degree view of these challenges.”

She and her team also observed various levels of school resources available for students with advanced medical needs. “We learned how schools function and recognized that schools with fewer resources would need more customized care.”


Future plans

Dr. Gandhi mentioned expanding the DASH program to include more staff, particularly diabetes nurse educators, advanced nurse practitioners and pharmacy staff. Having more staff, she noted, will expand the program’s reach to more schools and provide an opportunity for telehealth care.

“The DASH program is a great collaborative effort to help students with T1D manage their diabetes in all settings,” she said, emphasizing the need for consensus guidelines for managing T1D in schools.



Diabetes and School Health (DASH) Program: An Innovative Community-Based Care Coordination Program to Optimize Care and Reduce Inequities for Youth with Type 1 Diabetes. Poster presentation. ISPAD 2023.

About the author

JoAnna Pendergrass, DVM, is a veterinarian and freelance medical writer in Atlanta, GA. She received her veterinary degree from the Virginia-Maryland College of Veterinary Medicine and completed a 2-year postdoctoral research fellowship at Emory University’s Yerkes Primate Research Center before beginning her career as a medical writer.

As a freelance medical writer, Dr. Pendergrass focuses on pet owner education and health journalism. She is a member of the American Medical Writers Association and has served as secretary and president of AMWA’s Southeast chapter.

In her spare time, Dr. Pendergrass enjoys baking, running, and playing the viola in a local community orchestra.