P-66: Coping with type 1 diabetes during external examinations: young people’s experiences of stress, self-management, and school-based support
C Agwu, C Avann, W Osborne, S Vallender, L Hudson, M Nagularaj, S Kanumuri, M Samhat, O Koroye, R StackAbstract
Introduction
Examination periods introduce significant physiological and psychological stress for adolescents with Type 1 diabetes (T1D), often affecting glycaemic control and cognitive performance. Young people report inconsistent implementation of exam-related diabetes accommodations, highlighting a need for clearer evidence to inform equitable educational policies.
Objectives
To explore how adolescents with T1D experience and manage their condition during high-stakes academic examinations, with a focus on stress and the role of school-based support
Methods
Semi-structured qualitative interviews were conducted with 28 adolescents living with T1D. Interviews were coded line-by-line and analysed using thematic analysis.
Results
Participants described highly variable glycaemic responses to exam stress, with both hyper- and hypoglycaemia reported as impairing concentration and memory. Stress generated psychosocial feedback loops, heightening vigilance and contributing to increased cognitive load. Students monitored glucose levels repeatedly before and during exams, balancing fear of disruption with the demands of academic performance. Alarms from diabetes technology caused embarrassment, stigma, and sometimes confusion among invigilators. Routine and predictability were identified as protective factors that supported stable glycaemic control. Positive school experiences included proactive planning, clear communication of accommodations, and staff-wide awareness. However, experiences varied considerably; some students encountered inconsistent invigilator understanding, uncertainty around adjustments.
Conclusions
Adolescents managing T1D during examinations face substantial physiological, emotional, and cognitive burdens. Predictable routines and proactive, consistent school-based support reduce stress and improve exam experiences. Findings highlight the need for standardised, clearly communicated exam accommodations and increased staff education to ensure equitable academic conditions for students with T1D.