Educational outcomes among children with type 1 diabetes: Whole‐of‐population linked‐data study

Abstract

Background: Challenges with type 1 diabetes (T1D) blood glucose management and illness-related school absences potentially influence children's educational outcomes. However, evidence about the impact of T1D on children's education is mixed. The objectives were to estimate the effects of T1D on children's educational outcomes, and compare time since T1D diagnosis (recent diagnosis [≤2 years] and 3 to 10 years long exposure) on educational outcomes. Methods: This whole-of-population study used de-identified, administrative linkeddata from the South Australian Early Childhood Data Project. T1D was identified from hospital ICD-10-AM diagnosis codes (E10, ranging E101 to E109), from 2001 to 2014. Educational outcomes were measured in grade 5 by the National Assessment Program-Literacy and Numeracy (NAPLAN, 2008-2015) for children born from 1999 to 2005. Analyses were conducted using augmented inverse probability of treatment weighting. Multiple imputations was used to impute missing data. Results: Among 61 445 children born in South Australia who had undertaken NAPLAN assessments, 162 had T1D. There were negligible differences in the educational outcomes of children with and without T1D, and between recently diagnosed and those with longer exposure. For example, the mean reading score was 482.8 ± 78.9 for children with T1D and 475.5 ± 74.3 for other children. The average treatment effect of 6.8 (95% CI-6.3-19.9) reflected one-tenth of a SD difference in the mean reading score of children with and without T1D. Conclusion: Children with T1D performed similarly on literacy and numeracy in grade 5 (age 10-years) compared to children without T1D. This could be due to effective T1D management. K E Y W O R D S augmented inverse probability weighting, childhood, educational outcomes, linked-data, type 1 diabetes 1 | INTRODUCTION Children with Type 1 diabetes (T1D) are dependent on exogenous insulin their entire lives due to the immune-mediated destruction of their insulin-producing pancreatic beta cells. In the last few decades,

Association of type 1 diabetes and educational achievement in 16–20‐year‐olds: A Danish nationwide register study

“…Other studies found no difference in exam GPAs, 14 and two population-based studies found no differences in national test scores between individuals with and without T1D. 11,15 Differences in outcome measures may partly account for some of the inconsistency between studies, for example, assessments versus final exams. Contrary to the existing literature, 11,14-17 we found that T1D is associated with an increased risk of not completing compulsory school.…”

“…We confirm the negative association between HbA1c and educational outcomes found in previous studies. 11,12,14,15 Chronic hyperglycaemia is associated with changes in the grey matter volume of the brain and disturbed sleep. Acute dysregulations during tests have been found to be associated with worse academic test scores.…”

“…[5][6][7][8][9][10] Furthermore, T1D-related school absenteeism may have educational consequences. [11][12][13][14] Population-based studies have examined how T1D affects public school test scores, 11,12,15 and three have studied completion of compulsory school. 14,16,17 The most recent studies (inclusion-ages 7-14 years) show no differences in public school test scores and no difference in grade point averages (GPAs).…”

“…14,16,17 The most recent studies (inclusion-ages 7-14 years) show no differences in public school test scores and no difference in grade point averages (GPAs). 12,14,15 However, two older nationwide studies found significantly lower GPA among individuals with T1D. 16 Furthermore, the null results may be driven by selection bias since only enrolled students are included and T1D may impact enrolment.…”

The Impact of Hypo- and Hyperglycemia on Cognition and Brain Development in Young Children with Type 1 Diabetes

“…A recent study conducted in South Australia evaluated educational outcomes in children with T1D while also comparing the effect of times from T1D diagnosis (<2 years vs. 3–10 years). This study did not show differences in educational outcomes between children with T1D and controls, regardless of time since diagnosis [14].…”