School Restroom Diabetes Care Associated With Higher HbA1c in Japanese Children

A multicenter cross-sectional study published in Diabetes Care examined where children with type 1 diabetes performed self-management at school and how care location related to glycemic control. Researchers analyzed 2018 registration data from 1,105 children attending schools or preschools in Japan, evaluating associations among HbA1c, care behaviors, location, treatment modalities, age, and sex.

Mean HbA1c was 8.01% (SD 1.12%). Reported care locations included classrooms (36.9%), designated rooms (52.6%), and restrooms (5.9%). Mean HbA1c was higher among restroom users, at 8.56%, than among classroom users (8.00%) or designated-room users (7.95%; P < 0.001). Restroom use and omission of prelunch blood glucose monitoring were independently associated with higher HbA1c. Pump use, continuous glucose monitoring, and male sex predicted greater classroom use and less restroom use.

Classroom use declined after age 6, corresponding to elementary school entry. Restroom use emerged from age 11 and rose markedly at age 16 to 20.8%, coinciding with high school entry, including among pump users. The findings support attention to appropriate care spaces and school-wide understanding during educational transitions. However, the cross-sectional design cannot establish whether care location causes differences in glycemic control. The analysis used 2018 data, and only the abstract was available for this report.