Young people with type I diabetes mellitus: the influence of the school environment on self-care

Type 1 diabetes mellitus is now the third most common chronic illness in children and young people in the United Kingdom, with a twofold increase in incidence in the last decade. Diabetes self-care is integral to the young person's survival, and significantly reduces the risk of cardiovascular disease and microvascular damage associated with the condition. Parental involvement and family support is known to promote adherence to self-care. However adolescence is a period strongly associated with poorer adherence, as young people separate from the influence of their parents and form closer relationships with peers. Young people spend increasing periods of time at school in the company of personnel and peers, but little is known of how the school environment influences self-care. A qualitative study was undertaken, using a grounded theory approach to examine the role of the school environment in the self-care. Nine young people with type 1 diabetes mellitus aged between eleven and sixteen years were interviewed, regarding their experiences of managing their diabetes at school. A core concept of negotiating threats to self-regulation emerged, both to homeostasis and to the self. Threats included stigma in relation to having diabetes and associated self-care, and also the threat of self-exposure through the behaviours associated with hypoglycaemic and hyperglycaemic episodes. Participants sought to manage threats through negotiating the disclosure of their diagnosis, and concealing or omitting self-care. School personnel peers, and school rules played a part in this dynamic and evolving process. Friends acted as advocates, moderating threats to self-regulation and promoting self-care. School personnel and the application of school rules also influenced threats to self-regulation.