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Educational outcomes worse for children with type 1 diabetes
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Missing school and needing special education services are more common for children with type 1 diabetes compared with healthy children, according to findings published in Diabetes Care, with researchers noting that a higher HbA1c exacerbates these issues.
“Compared to peers, children with diabetes are more likely to die, be hospitalized, be absent from school and have learning difficulties. Among children with diabetes, higher HbA1c is associated with increased absenteeism and exclusion, poorer attainment and higher risk of unemployment,” Michael Fleming, BSc Hons, MSc, PhD, a statistician in the Institute of Health and Wellbeing at the University of Glasgow in Scotland, told Endocrine Today. “Interventions are therefore required to help and support children with diabetes, monitor their HbA1c, and minimize school absence to ensure that it does not adversely affect educational attainment and other outcomes.”
Fleming and colleagues identified 3,330 children aged 4 to 19 years with type 1 diabetes (48.3% girls) among a cohort of 766,047 children in nine databases across Scotland from 2009 to 2013. The databases compiled information on demographics, health, prescriptions and education for the cohort. A type 1 diabetes diagnosis was assumed for children who received insulin.
The adjusted incidence rate ratio (aIRR) for missing school was higher for children with vs. without type 1 diabetes (aIRR = 1.34; 95% CI, 1.3-1.39). An HbA1c level between 9.8% and 18% led to the highest incidence rate (aIRR = 1.75; 95% CI, 1.56-1.96); rates for those with an HbA1c between 9% and 9.8% (aIRR = 1.39; 95% CI, 1.23-1.56) and between 8.4% and 9% (aIRR = 1.23; 95% CI, 1.11-1.39) were also elevated. The incidence of school exclusion was also highest for those with an HbA1c of 9.8% or more (aIRR = 2.82; 95% CI, 1.14-6.98) and those with an HbA1c between 9% and 9.8% (aIRR = 2.75; 95% CI, 1.06-7.11).
In terms of special education, the odds of needing such services were more than doubled for those with type 1 diabetes, after all adjustments, compared with those without diabetes (aOR = 2.45; 95% CI, 2.26-2.66). According to the researchers, for girls (aOR = 3; 95% CI, 2.66-3.38) and those younger than 11 years (aOR = 3.73; 95% CI, 3.28-4.23), the chances that special education services would be required were tripled. In addition, Fleming noted that the significant associations between type 1 diabetes and special educational needs were specific to learning difficulties (aOR = 1.19; 95% CI 1.03–1.38), physical motor disabilities (aOR = 1.55; 95% CI 1.13–2.12) and physical health conditions (aOR = 24.08; 95% CI 21.83–26.57).
Although the researchers found that having type 1 diabetes did not necessarily lead to poorer education attainment or unemployment after schooling, those with an HbA1c between 9.8% and 18% were at greater risk for “low/basic attainment” (aOR = 3.52; 95% CI, 1.72-7.18) and unemployment (aOR = 2.01; 95% CI, 1.05-3.85).
Outside of educational findings, the researchers noted that rates of hospitalization (aHR = 3.97; 95% CI, 3.79-4.16) and mortality (aHR = 3.84; 95% CI, 1.98-7.43) were both higher for children with type 1 diabetes compared with those without the disease. Hospitalization incidence was particularly high during the first year following diagnosis (aIRR = 4.43; 95% CI, 4.13-4.75), according to the researchers.
“Type 1 diabetes is a chronic disease that exerts both a physical and a mental burden on those affected,” Fleming said. “It is important to further understand the mechanisms underpinning the observed associations. These are likely to involve both direct and indirect factors.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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