Diabetes Care at School: The DASH Program

The traditional way of caring for Type 1 diabetes is incredibly challenging even in the best of situations – four (or more) daily finger pricks to measure glucose levels, counting carbohydrates to calculate insulin doses, regular insulin injections.

That’s not all, by a long shot. The Nationwide Children’s Hospital Managing Your Diabetes resource book has 20 chapters of detailed information.

But some children with Type 1 diabetes are not in ideal situations. Caregivers may not understand the nuances of condition management, or transportation to medical appointments may not be available, or a fear of needles may make insulin injections especially difficult. These and other obstacles can lead to life-threatening complications.

It’s for these children in particular that Nationwide Children’s created its innovative Diabetes and School Health, or DASH, program in 2021. A specially trained team meets with students enrolled in the program monthly at their schools and coordinates ongoing care with school nurses.

The program is now available at 65 schools across 12 districts in central Ohio, plus another 12 charter schools.

“We think of DASH as a community-based health equity initiative,” said Terri Dachenhaus, RN, clinical leader for DASH and the separate school-based asthma therapy program. “We want to reduce inequities for youth who have Type 1 diabetes, especially for those who are also at the highest risk for complications.”

That risk is calculated with a composite score of nine different ratings. Much of that score comes from factors measured by blood work, like A1C, but it also considers factors such as how often (or how little) a young person regularly sees an endocrinologist. A patient who misses more routine medical visits is considered more at risk, as is one who regularly needs urgent or emergency care for uncontrolled diabetes.

Three years into the program, much of the focus is on making diabetes management as seamless as possible, said Dachenhaus. That can often best be accomplished by establishing the use of continuous glucose monitors and insulin pumps for the young people enrolled in the program. Those technologies help the students stay at a steady blood glucose level and avoid the spikes and deficits that can lead to complications.

They also reduce the need for those finger pricks and traditional insulin injections that can be difficult or scary to administer. The monthly team visits to each school remain crucial, though, to adjust and replace devices and to make sure that students and schools have the medications and resources they need.

“We’ve built a lot of trust with the students and with school staff,” said Dachenhaus. “Kids get frustrated when they have a condition that requires this much maintenance. We all would. School nurses aren’t always confident helping support a child with Type 1 diabetes. Now, we’ve helped remove some of the students’ frustrations, and school nurses tell us they feel more comfortable.”

Among the program’s biggest successes is an increase in use of continuous glucose monitors from 16% of eligible students to 81%.

DASH is a labor-intensive program, with the care team visiting dozens of schools every month. So for now, the program is limited to schools that are approximately a 45-minute drive from Nationwide Children’s. DASH is also working to collect data to learn the impact it has had on metrics such as emergency department visits.

“What we already know is that DASH has had an effect on students’ self-efficacy and their understanding of their conditions,” said Dachenhaus. “It’s been a success for young people and their families.”