Diabetes in children and adolescents in the school context: a systematic review

Abstract

Childhood and adolescent diabetes mellitus (DM) present public health challenges. Schools are central to DM management, but inadequate readiness, staff training, and coordination may compromise care quality. Thus, this study aims to systematically review the literature to identify the risk factors, institutional barriers, and management needs of children and adolescents with Diabetes Mellitus (DM) within the school context. A systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251111805). Searches were conducted in August 2025 across PubMed, Scopus, Web of Science, ScienceDirect, and Virtual Health Library. Included were observational and qualitative studies published between 2019 and 2025 addressing DM management in schools. Methodological quality was assessed via JBI critical appraisal checklists, and the certainty of evidence was evaluated using the GRADE system. Data were synthesized narratively. A total of 28 studies comprised the final sample. Methodological quality varied, and the overall certainty of evidence ranged from moderate to very low. Findings demonstrate that inadequate glycemic control is significantly associated with poorer academic performance and absenteeism. Furthermore, schools present major gaps in preparedness, often lacking trained staff and clear protocols for glycemic monitoring, which negatively correlates with student safety and parental satisfaction. DM management in schools is hampered by structural barriers, insufficient staff training, and technological conflicts. Effective management requires robust intersectoral policies; however, the predominance of cross-sectional designs limits causal inferences, underscoring the need for longitudinal studies to strengthen the certainty of evidence.