Intensive insulin therapy in the primary school setting : a meta-ethnographic synthesis

Aim: To explore how intensive insulin therapy is integrated into the primary school setting, to identify support strategies in order to inform policy and practice. Data sources: Articles between 2005 and 2015, children aged 4-12 years. Review methods: A meta-ethnographic comparative approach, using reciprocal translation and line of argument synthesis. Findings: Fourteen studies with qualitative data were included. Seven major metaphors were identified: Oh, it's needles, cover your back, worried about safety, great expectations, I'm not a diabetes expert, like everyone else and working together. Conclusion: A line of argument and conceptual model was developed from the metaphors and identified; competent diabetes care, risk management and a sense of normality and understanding as key areas that required addressing to improve integration of intensive insulin therapy. Collaboration and planning between the home, health, education and legal systems is also essential.