Supporting diabetes self-care in school is important for optimal glycemic control and mental health. The aim of this study was to investigate parental experiences of diabetes management in Danish schools, with an emphasis on the importance of school staff support in self-care. This cross-sectional study surveyed parents of schoolchildren with type 1 diabetes aged 6 to 16 years in Denmark. The parents were identified among members of the Danish Diabetes Association and were invited to complete an online questionnaire. A total of 252 parents of schoolchildren with type 1 diabetes answered the questionnaire. Only 28% of the children had a designated staff member responsible for support in diabetes self-care during school hours. Having a designated staff member responsible for support in self-care was positively associated with parental experiences of better school–parent cooperation (p < 0.001), better experience of diabetes management in school (p < 0.001), and larger proportions of children and parents feeling comfortable in school (p = 0.022 and p = 0.049, respectively). School staff support was positively associated with better parental experience of diabetes management and with some parameters of mental health in schoolchildren with type 1 diabetes and their parents in Denmark.

Managing diabetes is complicated for many children. It often requires support from an adult during the school day. In Denmark, most children spend 30–35 h a week at school. Nevertheless, diabetes management in schools remains largely uninvestigated. This study aimed to examine the characteristics and organization of diabetes management in Danish primary schools from the personnel’s perspective. All primary schools in Denmark were invited to participate in the study (n = 2129), and 525 schools were included. A questionnaire was constructed and sent by email. Questionnaire data are presented in the descriptive statistics and compared with the ISPAD guidelines. According to 77.2% of respondents, school personnel had received training in diabetes management, and 78.5% of the schools had at least one person available for diabetes support every day. Respondents felt prepared to help the students with counting carbohydrates (38.9%), dosing insulin (39.1%), and helping the students during high (52.1%) or low (60.3%) blood sugar levels, insulin chock (35.2%), or during activities (36.3%). Yet, diabetes management was a challenging task. Only 61.7% had an action plan for diabetes management, 37.4% had face-to-face information meetings with the parents, and 55.1% of respondents reported having sufficient time to cooperate with the parents.

Diabetes care in institutional settings is a significant challenge that affects the whole family as well as care workers and teachers. The present study is the ideation part of a rigorous development process in the KIds with Diabetes in School (KIDS) project. We have previously conducted a thorough three-part needs assessment in which we explored the problem area from the viewpoints of (1) municipal administrative staff, (2) preschool and school staff and (3) families. Based on the identified needs and to a great extent on the contents and shortcomings of existing guidelines, the objective of the present study is to explore and develop possible solutions and recommendations for addressing the challenges and problems. To meet this objective, we held comprehensive multistakeholder participatory workshops in each of the five Danish regions. Five main themes with multiple subthemes were identified as areas to be addressed: (1) training and knowledge, (2) communication and collaboration, (3) the designated contact/support person, (4) national guidelines, and (5) the Diabetes Coordinator. Our findings demonstrate that communicative structures and dynamics are at the very heart of the identified problems and challenges and that the possible solutions should revolve around improving existing structures and highlighting the importance of constantly working on understanding and developing communication strategies. We propose a set of recommendations for practice based on these communicative needs.

Diabetes care during institutional hours is a major challenge affecting the whole family. The aim of this study was to highlight challenges and potentials regarding municipal support in relation to diabetes care of children in school, kindergarten, and daycare. The dataset consists of 80 semi-structured online interviews with 121 municipal employees from 74 (of 98) municipalities in Denmark. Data were analysed using qualitative content analysis. The analysis produced four main themes: (1) Institutional staff initially feel insecure about diabetes care responsibilities, (2) There is a high degree of parental involvement and responsibilities during institutional hours, (3) The roles of health employees vary, and (4) Fluctuating allocation of special needs assistants (SNAs) creates challenges. The findings of this nationwide qualitative study show that, even though Denmark guarantees, by law, the child’s right to support in diabetes self-care in school and childcare institutions, diabetes management in Denmark still needs to be improved, with a view to ensuring equal support for all children with diabetes.

The 2023 Nordic Nutrition Recommendations (NNR23) presented a dual focus on disease prevention and planetary health. We aimed to develop a food-based diet score measuring adherence to NNR23 and assess its association with all-cause mortality in a Swedish population. We developed a novel diet score with 15 food components representing NNR23. Each component was scored between 0 and 1 point on a continuous scale, 1 being full adherence, based on participants' intakes. The study population included women (48-83 years old) from the Swedish Mammography Cohort (SMC, n=39,984) and men (45-79 years old) from the Cohort of Swedish Men (COSM, n=48,850), who completed food frequency questionnaires (FFQ) in 1997, 2009 and 2019 and were followed up though linkage to the National Death Register. Multivariable adjusted Cox proportional hazards regression models with age as the underlying timescale were used to estimate hazard ratios (HRs) with 95 % confidence intervals (CIs) for the association between adherence to NNR23 and all-cause mortality, as well as cardiovascular- and cancer-specific deaths. The median NNR23 score was 9.5 (p10, p90; 8.3, 11) for women and 8.9 (p10, p90; 7.4, 10) for men; no participant achieved full adherence. During a median 18.8 years of follow-up 30,142 participants died. Participants with the highest adherence (>10 points) at baseline had a 23% lower all-cause mortality (HR 0.77, 95% CI 0.74, 0.80) compared to the lowest adherence group (<8 points). Results were similar for cardiovascular- and cancer-specific mortality. For long-term average food intake, we found an even lower mortality risk when comparing highest adherence with lowest adherence (HR 0.38, 95% CI 0.37, 0.40). With a new food-based diet score representing NNR23, we found that higher compared to lower adherence to NNR23 was associated with lower mortality in a Swedish population.