Testing in schools

I was somewhat idly wondering today why we test for scoliosis in schools, but not for diabetes. If approximate a third of cases of type 1 are undiagnosed, and one in every 400-600 kids has type 1, chances are there's probably at least a couple of undiagnosed kids in each school. And as it's so much more dangerous untreated than scoliosis...

It seems like it would be super easy to test for also, you could go through a whole class in just a few minutes.

Anyway, I was just wondering.

as far as what's out there in internet land, incedence of scoliosis is 1 in 333 (but it's a unverified stat from wrongdiagnosis.com and kids.emtv.com)

at least I think (JDRF has T1d stats in the US and childstats.gov has the population) the incidence if T1D in "children" is near 1 in 5000.  so that makes scoliosis an order of magnitude more prevalent.  So - it's not likely that there is an undiagnosed T1d in a given grade, middle, or high school, but it is likely that there's a undiagnosed scoliosis issue.

Really? I thought I read somewhere it was more like 1 in 400-600 kids.

Maybe my logic is faulty... In my daughter's grade school there are three type 1 diabetics (that I am aware of). And if the stats that 1/3 are undiagnosed, then it makes sense that there's at least one more in her school, right?

It just seems like such an easy thing to test for, I wonder why it isn't done.

It sounds like an interesting idea, and I had heard numbers like 1 in 400-600 kids as well.  However, this past year in my 1,200-student school there were 10 kids with diabetes, and I'm sure that other schools have fewer or even no children with diabetes.  So while some kids may be diagnosed early, I think it'd be harder to justify, especially to the school systems.  To test for scoliosis as they do in school only a qualified person is needed, but testing hundreds to thousands of kids' blood sugars would require meters and lancets and test strips, which cost a lot of money.  You could also argue for testing for cancer or asthma or something else with similar statistics.  There are so many diseases/conditions out there and its impossible to test for all of them at school.  But by testing for diabetes, you could potentially save the lives of many children...

Actually, I think the most worthwhile of tests to add to ones given through school systems would be the test for celiac disease.  Apparently as many as 1 in 100 people have it, but few people are ever diagnosed.

yeah I heard 1 in every 400-600 as well.

Either way the screening for scoliosis is noninvasive so its a easy one and it can be very dangerous even deadly depending on the type of scoliosis it is. 

In Rileys school with around 500 kids we have 5 or 6 type 1's. The principle told me they were going to see if they could have someone from the Betty Davis center come down and train them on what to look for warning signs and such. That way kids wont need to get so bad my daughter in DKA before they get dxed. Last year 2 kids one being my daughter was dxed at the school. Thankfully the other girl knew the signs of t-1 cause her much older brother is  a t-1. She did come to me about it and I told her to have her mom bring her in to get tested asap. The next week she was not at school for 3 or 4 days. Her numbers were I believe in the 500-600 range same as my daughters but she was not in dka. Seeing it early can save both t-1 and their parents a lot of trauma.

ya this is why stats are easy to manipulate.

the JDRF states 14,000 new cases T1D, in Children, diagnosed per year.

Childstats/childrensdatabank, etc  has the approximate number of children in the US at 75MM.

so, if you want to know the incedence of undiagnosed children with T1D in the US, right now, it's over 1 in 5000. (and that's a totally different number than the number of children who know they have diabetes in the US, right now)

That isn't including adults, or anyone who "knows" they have diabetes, or anyone who got diagnosed last year, or their 4 brothers, etc. So if you had to guess how many undiagnosed children are in a school with 4,600 children attending, the answer is probably zero.

The 1 in 333 is the prevalence of scoliosis, or how many people suffer.  It's wrong to compare the incedence with the prevalence because they are not the same.  JAMA [vol 282, no 15, 10/1999] estimated the incedence of scoliosis at 1 in 448 for in-school testing.  JAMA does a real good job talking about the effectiveness for in-school screening. So then for scoliosis, the best guess (for the same made-up school) is probably 10 kids who need treatment...

Anyway, it's not so easy to screen for diabetes.  a kid with a juce box can have a random sugar of 180, in some cases higher, and it could mean nothing.  Screening is a good idea for a lot of things and I am a proponent of preventive medicine - I guess it just doesn't add up in this case, imo.


It might make more sense to make it part of yearly physicals at the pediatrician. That way, they wouldn't have to worry about sanitation related to blood if they were testing each child at school. It seems like a finger stick at a yearly check-up would be pretty cheap to the healthcare system compared to going to the ER in DKA...

They should start testing or at least making families very aware of the warning signs because although i wasn't yet in school when i was diagnosed i was 2 years old, my sister was in school. My parents really didn't know what type one diabetes was till obviously i was diagnosed... Also, this would start to ignore the ones that believe there is only one type on diabetes (type 2) 

Jessica, its actually the Barbara Davis Center.  But that would be really cool and good for a school to know the signs. When I was diagnosed my teacher said I had all the symptoms she just didn't know it at the time so training is really good.

They probably don't test for diabetes because it involves blood. In addition, some kids freak out when they get poked and scoliosisis tests are less invasive. I'm not saying that's a good thing, but it's a possible reason.

[quote user="Janna"]

Jessica, its actually the Barbara Davis Center.  But that would be really cool and good for a school to know the signs. When I was diagnosed my teacher said I had all the symptoms she just didn't know it at the time so training is really good.


lol Janna I actually knew that lol silly me. A bunch of people saw different signs we just didnt know what t-1 was to put it all together. Ri's teacher noticed increased urination. She kept getting sick and would randomly vomit but be fine the next day. She lost 22 pounds but we thought is was 10. There was a different explanation for it all. I am not at all big on doctors and their opinions. Which was proven right once again when we took her to the urgent care the day before her dx because she couldnt breath. They said she had strep and gave her liquid antibiotics. That was also when we learned she had lost 22 lbs and not 10 but they didnt test her sugars.

I think another big reason why this is not done in schools is because of the huge age variance of when people come down with type 1 diabetes.  I believe scoliosis shows signs at a certain point in development where diabetes comes at random ages thus you may test someones blood in 1st grade and tell the parents they don't have it to only have them come down with it in 8th grade.  It would be confussing to parents.  I definetly agree with the other posts here that doctors should educate parents and check ups of signs.

In our school of 545 kids Emmie is the only one and there has not been one there in the past 5 years. 

-Meg (Emmies mom, diagnosed 10/29/09 at age 4)

Another big reason is that scoliosis is a long-term developing condition. If you are checking 1x/yr, in the prevalent age groups, you will find the kids who have developed it since the last year and can get them started on treatment. If you miss it the first year and then catch it the next year, no real harm done.

T1 diabetes will have much faster onset (days, weeks, in some cases months), so unless you are checking weekly (or maybe monthly), you would not see very many diagnoses at an annual all school check. So it would be much better to just educate teachers and staff on the early signs of T1 and have a standard 1 page sheet that could be sent home to parents if someone at the school notices the signs. Though teachers will probably fall into the same trap as parents in that many of the changes in our kids happen slow enough that we don't really notice things like the weight loss, more frequent urination, drinking that it isn't until after dx that you sit there and say "why didn't I notice all these warning signs?"

I had always read 1 in 500 kids have Type 1 diabetes

there are 5 diabetics in our 1500 kid school so your stats do seem to make sense

Basically, scoliosis can often be treated and the effects corrected while type 1 diabetes cannot, so that's why there's really no point to randomly screen for it when it affects so few in the general population.  Type 1 diabetes is rarely left untreated with diagnosis usually made shortly after the onset of hyperglycemia with symptoms. 

Plus, at least in Canada, diagnosis cannot be made based on a fingerstick.  A lab test (test tube full of blood) needs to be done.

The American & Canadian Diabetes Associations are clear that their stats on undiagnosed diabetes cases mainly refer to type 2, as type 1 progresses very quickly with many symptoms leading to diagnosis.  Neither Association recommends routine screening for type 1 based on the fact that the screening doesn't prevent or delay the inevitable diagnosis which would be made regardless of whether or not screening had been done.

I think testing in schools would be an amazing idea!!

My diabetes just kinda showed up unannounced i had basically no symptoms. They really should get it approved to do testing in schools

Hello Michelle,

You bring up a very good point and question.  why don't they, and they should.  Very good observation and valid as well.  Who knows maybe one day you'll be the person to help make that happen.  Anything is possible and sometimes it just take one person to start an awareness campaign to get the issue noticed, it could be something the medicla industry or school does not believe is important enough, although it is and that may be why they don't test.  Or feel that it takes away from the Doctor's and or parent's rights.

Either way great idea and worth looking into.

Thanks all. I don't know if it's practical, but as long as so few people even have a clue what Type 1 diabetes is, and don't know the symptoms, it seems like there should be some mechanism for catching these things earlier. For goodness sake, even my daughter's pediatrician didn't catch it for about two years where I was constantly calling her about random attacks of vomiting, major moodswings we'd tied to mealtimes, and her insane thirst (which I can trace back to when  she was a toddler).

With so little awareness, it's a good thing relatively few kids are afflicted - but would be really nice if we could raise awareness or have a way to find these kids sooner. What happens to kids who don't have attentive parents?

When I'm in school I test at the end of class before lunch, I'm to lazy to walk to the nurse :P