There is a growing concern that recent moves to restrict smartphone use in schools may adversely affect students with type 1 diabetes (T1D) who use the devices to manage their blood sugar levels during the school day.
Smartphones also enable parents or caregivers to monitor the child’s glucose levels remotely and to communicate with them if necessary.
In many countries including the UK and the US, policies that restrict or ban cell phone use during the school day are becoming more prevalent, in an effort to improve students’ focus and enhance learning. While medical use exemptions are typically granted, two UK T1D experts published a commentary in Clinical Diabetes expressing concern about “wider, unforeseen consequences” for children with T1D and their families, and recommending relevant research and policy priorities.
“It can be a lonely place when a medical condition forces you to stand alone facing a social wave being embraced by others,” commentary co-author Alice M. Gregory, PhD, a psychologist at Royal Holloway, University of London, Egham, England, and mother of a child with T1D, told Medscape Medical News.
Gregory and co-author Partha S. Kar, MD, Type 1 Diabetes and Technology Lead in the National Health Service England, reported several anecdotal issues that have arisen in the setting of smartphone bans. School personnel have suggested that children with T1D use phones discreetly or store them in pouches. Parents of children without diabetes have complained about smartphone use in front of their child. Parents have also reported increased stigma, a greater sense of “otherness,” and concern that the child with T1D might not be willing to use their phone in front of others even with an exemption.
“There was not one but a large number of events that led us to write this commentary. Some of those events I have experienced myself, and some are reported by other parents of children living with T1D,” Gregory told Medscape Medical News, adding “this is a topic that matters greatly to at least some of the families of children living with T1D and needs to be addressed in a research and clinical context.”
Asked to comment, Pediatric Endocrinologist Christine March, MD, of the University of Pittsburgh, Pittsburgh, and a member of the American Diabetes Association (ADA)’s Safe at School Working Group, told Medscape Medical News, “I think the authors raise valid questions about how these policies may affect parent and student experiences over time. Children with T1D may already perceive stigma or experience challenges related to using their diabetes devices in school. We will need to monitor whether this is exacerbated as a result of these bans.”
The Role of Diabetes Clinicians
According to Gregory, “Acknowledgement of this by pediatric endocrinologists and diabetologists is incredibly valuable as, not least, these people can help to bridge communication between those with lived experience and school staff for example.”
March proposed several ways in which clinicians can help families of children with T1D to navigate these bans. “First, we can clearly document in the medical orders what the student needs to support their diabetes management during the school day. We can also help parents with language which should be incorporated into a 504 plan for reasonable accommodations to use their smart device, like having access to the WiFi.”
And “we can strategize with children and families about how to use the devices in school while minimizing disruptions, for example by adjusting [continuous glucose monitor] alert settings.”
Smartphone Bans and Exceptions
In the UK, there has been a push toward a “smartphone-free childhood.” In February 2024, the UK Department for Education issued guidance for carrying out these initiatives that includes the statement “Where mobile phone use allows pupils to manage their medical condition effectively, it would not be reasonable for a school to prevent this.”
In the US, at least 31 states and the District of Columbia require school districts to ban or restrict students’ use of cellphones in schools, according to Education Week.
The ADA’s legal advocacy department has compiled a list of statewide school cell phone restrictions created by law or policy, along with major city or county policies, and whether they include medical exemptions. In cases where there is no clear medical exemption in the policy, the cell phone restrictions are usually more loosely defined and may fall to individual school districts, March noted.
The ADA has also released a statement saying that children with diabetes who use smart devices as part of their management should be permitted access to them during school for their medical care. A downloadable card that students can carry, explaining why they need a smart device for their medical care, is also available.
And the most recent version of the ADA Diabetes Medical Management Plan, which includes the medical orders provided by the treating clinician for school, also contains language to indicate that a smartphone is medically necessary.
A Need to Explore Impact Beyond the Exemptions
Gregory and Kar said that more research is needed to understand the impact of smartphone bans that may arise even with the exemptions. Among their priorities are researching the experiences and consequences of the smartphone-free initiatives on children with T1D and their families, including social factors and mental and physical health, in both short- and long-term.
They also recommend consideration of factors predicting different responses to the bans, such as level of support from medical professionals, schools, and local communities, as well as individual factors. And they advise consideration of policy changes if deemed necessary to ensure equity.
“Given the pace of change and the level of international support for initiatives focusing on smartphone-free childhoods, the implications of these campaigns must be considered as a priority in research. Additionally, there need to be policies and clinical guidance and advocacy recommendations to support families and avoid unforeseen, and potentially severe, negative consequences of well-intentioned campaigns for individuals with T1D and their families,” Gregory and Kar concluded.
In the US, families experiencing difficulties with cell phone access at school can contact the ADA for help at 1-800-DIABETES or email at AskADA@diabetes.org.
Gregory is an advisor for a project initially sponsored by Johnson’s Baby and has been a consultant for Perrigo. She reported receiving royalties for two books and a commercial product related to sleep; being a former chief executive officer of Sleep Universal, Ltd.; and occasionally receiving sample products related to sleep. She has been a paid speaker for Investec and a paid author for Neurodiem. She sometimes gives other presentations for which expenses are paid and/or a stipend is paid. She is also the mother of a child with type 1 diabetes. Kar and March had no disclosures.
Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diatribe. She is on X @MiriamETucker and BlueSky @miriametucker.bsky.social.
