Challenges and Opportunities of Engaging School Nurses in a Diabetes Care Team in a Culturally Diverse Lowincome Community – a Mixed-methods Feasibility Study

Abstract

Objective: In this study, we evaluated the feasibility of monthly insulin dose adjustments for students with type 1 diabetes mellitus (T1DM) through collaboration between pediatric diabetes clinic and school nurses. Methods: We conducted a single-arm adaptive feasibility trial with 30 students from a culturally diverse low-income community. School nurses were trained to download glucose meters and insulin pumps. Outcomes measures included the rate of glucose meter/insulin pump downloads occurred versus planned. We conducted 2 focus groups (N = 23) to seek feedback from school and clinic nurses on the collaboration and used content analysis to identify common themes. Results: The rate of glucose meter/insulin pump downloads was 27%. Feasibility obstacles were grounded in lack of time for nurses and psychosocial stressors in the community. We found a trend toward better diabetes control during the school year versus summer. We identified better communication between the school and clinic nurses and ongoing diabetes education for school nurses as strengths of the pilot. Conclusion: We propose shared clinic visits, care coordination, and behavioral health support as directions for future programs. Our findings provide directions for policy development to strengthen school nurse collaboration with diabetes clinics and improve care of students with T1DM from culturally diverse low-income communities.