The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Public Health
Bureau of Environmental Health
250 Washington Street, Boston, MA 02108-4619
Phone: 617-624-5757 Fax: 617-624-5777
TTY:  617-624-5286

DEVAL L. PATRICK
GOVERNOR
TIMOTHY P. MURRAY
LIEUTENANT GOVERNOR
JUDYANN BIGBY, M.D.
SECRETARY
JOHN  AUERBACH
COMMISSIONER	

MEMORANDUM

To:	Individuals Interested in MDPH’s Public Health Activities Related to Type 1 Diabetes

From: 		Suzanne K. Condon, Associate Commissioner
Director, Bureau of Environmental Health

Subject:  	Status Report 

Date:		February 2010

The purpose of this memorandum is to provide an update on the Massachusetts Department of Public Health’s (MDPH) Bureau of Environmental Health’s (BEH) K-8 surveillance of pediatric diabetes in elementary and middle schools throughout the state and in an exploratory investigation in Weston, Wellesley, and Newton.  The exploratory investigation expands statewide school-based surveillance efforts and includes an effort to identify children diagnosed with type 1 diabetes from birth through high school. The three community investigation will allow, among other things, for an estimate of the prevalence of type 1 diabetes in ages 0 through 19.  

As part of the Environmental Public Health Tracking Program (EPHTP), staff in the BEH is currently collecting year 3 data on the number of children with diabetes in elementary and middle schools across the Commonwealth.  Through federal funding, the collection of EPHTP data constitutes the beginning of the surveillance of pediatric diabetes in the state and, to date, Massachusetts has the only statewide system of its kind in the United States.  

As mentioned, an exploratory, more focused investigation of type 1 diabetes in Weston, Wellesley, and Newton is being conducted using data from pre-schools, high schools, health care providers, and hospitals serving these three communities, so as to include ages 0 through 19 in the prevalence estimates for these communities.  In spring 2009, BEH sent a mailing to school nurse leaders in the three communities, requesting that they forward a letter and consent form, on the behalf of BEH, to the parents of children in their schools with type 1 diabetes. The consent form requested limited diagnostic and residential history information from parents to assist BEH in better understanding the prevalence and geographic distribution of type 1 diabetes in the three communities. Given the data access barriers imposed by the Family Educational Rights and Privacy Act (FERPA) interpretation, it was necessary to ask school nurses and administrative staff to facilitate the mailing.  The current interpretation of FERPA does not allow BEH access to student health information without the consent of their parents.  Based on K-8 surveillance and information provided by school nurses at the high schools, a total of 65 children/adolescents were thought to have a diagnosis of type 1 diabetes. BEH received actual responses/information from 55 families.  A second mailing to parents, again facilitated through the school nurses, is underway in an effort to receive a 100% response rate.

This investigation will allow for an evaluation of the spatial pattern of type 1 diabetes in these communities as well as a preliminary evaluation of some potential environmental risk factors identified in the epidemiological literature as having a possible role, along with genetic risk factors, in the development of type 1 diabetes.  As previously reported, the medical literature suggests that gene/environment interactions may be important in the development of autoimmune diseases like type 1 diabetes. 

A third mailing to health care providers serving the three communities is being prepared by BEH to include pre-school children in the prevalence estimates.  BEH staff worked with Dr. Lori Laffel at the Joslin Diabetes Center to identify those hospitals and clinics that treat children and adolescents from Weston, Wellesley, and Newton. By obtaining data from hospitals and clinics, BEH can supplement the school-based data by including children/adolescents who are not yet in school or attend private schools outside of their community of residence.  These more accurate prevalence estimates can then be compared to prevalence estimates in the medical/epidemiological literature.  A letter requesting this information from providers was drafted and is currently under review by Dr. Laffel. BEH anticipates this letter will be distributed via mail later this month.

To be placed on the MDPH mailing list for updates on BEH activities related to type 1 diabetes in children and adolescents in Massachusetts, please call 617-624-5757 and ask for the Community Assessment Program.