title: Impact of the Balanced School Day on Glycemic Control in Children with Type 1 Diabetes.
abstract: The balanced school day (BSD) is an alternative elementary school schedule whereby children have 2 20-minute eating periods instead of 1 20-minute lunch, as is found in the traditional schedule (TS). We assessed the glycated hemoglobin (A1C) levels of children with type 1 diabetes in the TS vs. the BSD because 2 eating periods have the potential to impact blood glucose control.
  
  
  
  A1C levels representative of the summer months (SumA1C) and A1C levels occurring at least 3 months after the start of the school year (SchA1C) were obtained retrospectively. A parental survey of perceptions of lunch planning, activity levels and diabetes management at school was also completed.
  
  
  
  Our sample included 97 students (TS=42, BSD=55). The mean age ± SD was 10.9±2.6 and 10.1±2.8 years in the TS and BSD, respectively (p=0.12). Sex distribution was not statistically different; 54% were female in TS vs. 36% in BSD; p=0.08. SumA1C was similar in the 2 groups (TS: 8.3±1.1% vs. BSD: 8.0±0.8%; p=0.08). There was a significant within-group increase from SumA1C to SchA1C in the BSD group only (p=0.001), with mean A1C values increasing from 8.0%±0.8% to 8.5%±1.0% in the BSD group compared to no significant increase in the TS group. Parental perceptions of lunch planning, physical activity and diabetes management were similar, regardless of school schedule.
  
  
  
  Children with type 1 diabetes in the BSD appear to have worse diabetes control during the school year compared to the summer, which is not evident in children in the TS. Additional school supports may assist students in the BSD.
authors.affiliation: Department of Pediatrics, Western University, London, Ontario, Canada.
authors.forename: Robert I
authors.initials: RI
authors.lastname: Stein
authors.affiliation: Department of Pediatrics, Western University, London, Ontario, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Manpreet
authors.initials: M
authors.lastname: Doulla
authors.affiliation: School of Food and Nutritional Sciences, Brescia University College, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Human Environments Analysis Laboratory, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Seabrook
authors.affiliation: School of Food and Nutritional Sciences, Brescia University College, Western University, London, Ontario, Canada.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Yau
authors.affiliation: London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Natasha
authors.initials: N
authors.lastname: Hamilton
authors.affiliation: Department of Pediatrics, Western University, London, Ontario, Canada.
authors.forename: Marina I
authors.initials: MI
authors.lastname: Salvadori
authors.affiliation: School of Food and Nutritional Sciences, Brescia University College, Western University, London, Ontario, Canada; Schulich Interfaculty Program in Public Health, Western University, London, Ontario, Canada. Electronic address: pdworatz@uwo.ca.
authors.forename: Paula D N
authors.initials: PDN
authors.lastname: Dworatzek
mesh_terms: D000293:Adolescent; D001071:Appointments and Schedules; D001290:Attitude; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D062409:Lunch; D008297:Male; D010290:Parents; D012189:Retrospective Studies; D012574:Schools; D013334:Students; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: balanced school day; children; diabète de type 1; enfants; glycemic control; régulation de la glycémie; school; type 1 diabetes; école