48 JH Yoo • Nonpharmacological management for children with T1DM families of children with T1DM and peer groups, opportunities to share information helpful to diabetes control should be provided30). All educational courses should progress step-by-step in conformity with age groups for easy understanding. Education on diabetes should be continuously reevaluated to ensure continual education on insufficient management31). I hope that in the near future, the operation of diabetes self-management education programs for children and adolescents with T1DM will be systematically evaluated and lead to discussions on effective education programs that are suited to the characteristics of the Korean society. Psychosocial Support Systems Adolescents with chronic diseases such as T1DM have been con- sidered as dangerous groups with high probability of the occurrence of psychological problems32). In particular, adolescent patients with type 1 diabetes must unceasingly overcome instinctive desires including those for comfort and appetite to control their diabetes, and the fear of chronic complications imposes more uncertainty on them as adolescents, resulting in significant psychological stress. It has been already confirmed in studies conducted on adults that depression was more than 2-fold more frequent in patients with diabetes than in the normal population, and there were reports indicating that diabetes combined with depression caused more serious disorders in social functions, creating greater difficulties in school or family life and even diabetes control33). It is also known that depression affects HbA1c levels and diabetic chronic complications, resulting in increased national health management costs and diabetes-related mortalities34). The most basic unit of psychosocial support systems is the patient’s family. In a study conducted on Korean children and adolescents35), glycemic control and depressive symptoms had close relationships, and the results of an analysis of parenting behaviors showed that there were fewer depression symptoms when parents knew more about the overall life of their children such as school life and friendships and when parents demonstrated parenting behaviors to consistently persuade their children with clear and reasonable criteria. Sociodemographic characteristics also existed such as the fact that high HbA1c levels were observed in low-income and single-parent families. Families with high scores in family cohesion, achievement orientation, agreement about diabetes management responsibilities, supportive behaviors, and collaborative problem-solving demonstrated smooth glycemic control. Families with high scores in conflicts and diffusion of responsibilities demonstrated poor glycemic control. Family-based behavior therapeutic approaches include goal setting, self-monitoring, positive reinforcement, behavioral contracts, supportive parental communication, and appropriately shared responsibility for diabetes management, and these strategies improve glycemic control36-38). In addition, parent-adolescent relationships were improved while implementing these approaches. When therapeutic approaches focusing on families were attempted, the participation of family members in treatment could be increased without decreasing the quality of life of the adolescents or causing family conflicts, and the deterioration of glycemic control could be prevented39). In Korea, it appears that institutions that educate children and adolescents on diabetes are rarely active in the operation of psychosocial support systems. I hope that many family-based behavior therapeutic approaches that are suitable to the characteristics of Korean families will be attempted so that excellent models can be presented. School-based support systems In the United States, federal laws that protect children with diabetes include Section 504 of the Rehabilitation Act of 1973, Individuals with Disabilities Education Act of 1991, and Americans with Disabilities Act. Owing to these acts, children with diabetes can be provided with various types of approaches necessary for appropriate diabetes control40). However, in Korea, where people’s perceptions of T1DM are insufficient, children with diabetes and their families should first make efforts to control diabetes well in school. Then, with the help of the members of diabetes care teams, they should sufficiently explain the needs of children with diabetes to their children’s homeroom teachers in school, school exercise trainers, and school nurses sufficiently through basic education on T1DM. Children with type 1 diabetes should be allowed to bring tools for blood glucose tests and the use of insulin to school. They should be allowed to freely test their blood glucose levels anywhere in school. They should be allowed to eat snacks freely for preventing and responding to hypoglycemia. They should be allowed to meet school nurses freely any time and receive immediate and effective treatment against hyperglycemia and hypoglycemia. They should be allowed to go to the toilet freely, even during class hours. They should be allowed to drink water freely. They should be allowed to participate not only in gymnastics but also in all field trips and extracurricular activities. School exercise trainers should be able to respond to hypoglycemia immediately and appropriately. The children should be sufficiently considered so that they are not disadvantaged because of hospitalizations or clinic visits. Currently, in Korea, depending on the policies of local education offices, welfare policies for children with diabetes are made on a case-by-case basis. Opportunities for Internet lectures in cases where children must miss school are increasing, and opportunities to attend