Education is a very important tool in the management of diabetes. It is regarded as one of the pillars of diabetes management. This has been the primary reason for the establishment of diabetes clinics to provide patient empowerment through education, leading to successful clinical outcomes.

We know that children with diabetes require so much attention. Good glycemic control requires frequent monitoring, strict medical nutrition therapy, and adherence to medication. Several factors may affect glycemic control. Frequent meals while in school; the presence of “temptations” such as soft drinks and junk food; peer pressure, the feeling of being “different” from the majority, the “embarrassment” of having hypoglycemic attacks in public, to name a few. It is therefore important to educate these children about the disease in order to achieve success in diabetes management.

Learning needs in children are different from adults. Thus, techniques in teaching must be appropriate for age. The abilities and attention span of children must also be considered in planning for the learning materials, content, and demonstration skills.

For preschool or early school age children, play-based learning would be the best approach. The use of materials such as The use of materials such as coloring books, toys, or dolls can be very effective education tools. Parents must be present during diabetes management at home. School-age children learn well when instructions are presented in a fun way such as games. With the advent of fast-paced technology, computer-based games may be effective tools. The use of common children games, incorporated with diabetes education, is very effective. Even if at this age, the parents are still the ones performing the diabetes management, it would be good to start teaching them this young about basic diabetes self-management.

For adolescents, diabetes education can be incorporated in puberty issues. The use of peers during the discussion can be very helpful. This strengthens acceptance, independence, and confidence issues. At this age group, the use of technology, such as computers, and books can be utilized. One-on-one sessions with the healthcare professionals can be helpful with this age group.

Diabetes education is very important. Those who never had access to education had the worst clinical outcomes. Thus, in 2009, the International Society for Pediatric and Adolescent Diabetes came out with the consensus guidelines on diabetes education in children.

The following are the universal principles in diabetes education in children:
Every young person has a right to comprehensive expert structured education which should empower them and their families to take control of their diabetes

• Children and adolescents, their parents, and other care providers should all have easy access to and be included in the educational process.
• Diabetes education should be delivered by healthcare professionals with a clear understanding of the special and changing needs of young people and their families as they grow through the different stages of life.
• Diabetes education needs to be adaptable and personalized so that it is appropriate to each individual’s age, stage of diabetes, maturity, and lifestyle; culturally sensitive; and at a pace to suit individual needs.
• The priorities for healthcare professionals in diabetes education may not match those of the child and family. Thus, diabetes education should be based on a thorough assessment of the person’s attitudes, beliefs, learning style, ability and readiness to learn, existing knowledge, and goals
• Educators (doctors, nurses, dietitians, and other healthcare providers) should have access to continuing specialized training in diabetes education and educational methods
• Diabetes education needs to be a continuous process and repeated for it to be effective.

The topics needed to be discussed must be age-appropriate.

School-age children

• Adjusting to the change from home to school, developing self-esteem and peer relationships
• Learning to help with and developing skills in injections and monitoring
• Progressive recognition and awareness of hypoglycemic symptoms
• Increasing understanding and self-management
• Adapting diabetes to school programs, school meals, exercise, and sports
• Including monitoring of blood glucose levels and injections in the school setting
• Advising parents on the gradual development of the child’s independence with progressive stepwise handover of appropriate responsibilities

Adolescents

• Accepting the critical role of continued parental involvement and yet promoting independent, responsible self-management appropriate to the level of maturity and understanding
• Understanding that knowledge about diabetes in adolescence is predictive of better self-care and (metabolic) control but the association is modest
• Discussing emotional and peer group conflicts
• Teaching problem-solving strategies for dealing with dietary indiscretions, illness, hypoglycemia, sports, smoking, alcohol, drugs, and sexual health
• Negotiating targets, goals, and priorities and ensuring that the tasks taken on by the adolescent are understood, accepted, and achievable
• Understanding that omission of insulin is not uncommon. The opportunity should be grasped for non-judgmental discussion about this
• Developing strategies to manage transition to adult services.

The Philippine Center for Diabetes Education Foundation has embarked on teaching children with diabetes through a camping program called “CAMP COPE”. In this program, children with type 1 diabetes are taught on diabetes and its management. Sessions are designed to be play-based and fun. Examples of which are relay games (for insulin injection), acting out (for hypoglycemia and hyperglycemia), and artwork (for expression of personal issues). They are guided by a team composed of doctors, dietitians, nurses, and counselors (who themselves have learned to cope with the disease).

Children must be provided proper diabetes education. It is the key to successful diabetes management.

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