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Joint "Dear Colleague" Letter to Chief State School Officers


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April 14, 2005

Dear Chief State School Officer:

Diabetes is one of the most common chronic diseases in school-aged children, affecting about 206,000 young people in 2002. The most common form of diabetes in youths is type 1 diabetes, formerly called juvenile diabetes. About one in every 400 to 500 children and adolescents has type 1 diabetes. Along with the epidemic of overweight and obese children, more and more children and teens are now being diagnosed with type 2 diabetes, formerly called adult onset diabetes—even though the disease is usually diagnosed in adults over age 40.

Diabetes must be managed 24 hours a day, 7 days a week. For most students with diabetes, that means careful monitoring of blood glucose levels throughout the school day and administering multiple doses of insulin therapy or using a continuous insulin pump. Too much insulin can lead to dangerous low-blood-sugar reactions, while chronic increased blood sugar puts youths with diabetes at risk of long-term complications. Since monitoring and therapy occur during the school day, the school health team—including school administrators, school nurses, principals, teachers, office personnel, and other staff members—plays a critical role in helping students manage their diabetes.

The U.S. Department of Health and Human Services’ National Diabetes Education Program (NDEP), jointly sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention, has established a Diabetes in Schools Initiative. The purpose of the initiative is to educate school personnel about the benefits of optimal diabetes management and to help ensure a supportive environment and equal access to educational opportunities for students with diabetes. Working with experts in diabetes, pediatric medicine, school nursing, and education, the NDEP has produced Helping the Student with Diabetes Succeed: A Guide for School Personnel to address the needs of all students with diabetes. The U.S. Department of Education participated in this effort by developing parts of the guide and providing an overview of the federal civil rights and privacy laws that address schools’ responsibilities in educating students with disabilities.

With this new guide, school administrators and health services personnel now have a comprehensive resource that:

  • Lays out a team approach to diabetes management in the school setting;
  • Provides a basic primer and glossary about diabetes;
  • Reviews components for planning and implementing effective diabetes management;
  • Contains sample action plans that alert school personnel to common signs and symptoms of high and low blood glucose levels and how to handle emergencies; and
  • Reviews the federal laws pertaining to schools’ responsibilities to educate students with disabilities.

The guide may be reproduced and distributed without copyright restrictions. Additional copies may be downloaded from the NDEP Web site at or they may be ordered by calling 1-800-438-5383. Feel free to promote the availability of this important resource to your colleagues and staff and to create a link to the school guide on your Web site. Please put this guide to work in schools throughout your state so we all can help every student with diabetes succeed.


James F. Manning
Delegated the Authority of
Assistant Secretary for Civil Rights
U.S. Department of Education

Judith E. Fradkin, M.D.
Director, Division of Diabetes,
Endocrinology, and Metabolic
National Institute of Diabetes and
Digestive and Kidney Diseases
National Institutes of Health

James R. Gavin III, M.D., Ph.D.
Chair, HHS National Diabetes
Education Program

Last Modified: 01/10/2020