Educational and Health Outcomes of Children Treated for Type 1 Diabetes: Scotland-Wide Record Linkage Study of 766,047 Children

Abstract

Objective: This study was conducted to determine the association between childhood type 1 diabetes and educational and health outcomes.

Research design and methods: Record linkage of nine Scotland-wide databases (diabetes register, dispensed prescriptions, maternity records, hospital admissions, death certificates, annual pupil census, school absences/exclusions, school examinations, and unemployment) produced a cohort of 766,047 singleton children born in Scotland who attended Scottish schools between 2009 and 2013. We compared the health and education outcomes of schoolchildren receiving insulin with their peers, adjusting for potential confounders.

Results: The 3,330 children (0.47%) treated for type 1 diabetes were more likely to be admitted to the hospital (adjusted hazard ratio [HR] 3.97, 95% CI 3.79-4.16), die (adjusted HR 3.84, 95% CI 1.98-7.43), be absent from school (adjusted incidence rate ratio [IRR] 1.34, 95% CI 1.30-1.39), and have learning difficulties (adjusted odds ratio [OR] 1.19, 95% CI 1.03-1.38). Among children with type 1 diabetes, higher mean HbA_1c (particularly HbA_1c in the highest quintile) was associated with greater absenteeism (adjusted IRR 1.75, 95% CI 1.56-1.96), increased school exclusion (adjusted IRR 2.82, 95% CI 1.14-6.98), poorer attainment (adjusted OR 3.52, 95% CI 1.72-7.18), and higher risk of unemployment (adjusted OR 2.01, 95% CI 1.05-3.85).

Conclusions: Children with type 1 diabetes fare worse than their peers in respect of education and health outcomes, especially if they have higher mean HbA_1c. Interventions are required to minimize school absence and ensure that it does not affect educational attainment.

Figure 1

Forest plot of the association between treatment for diabetes and special educational need by sex, age, and area deprivation, adjusted for age, sex, deprivation quintile, ethnic group, maternal age, maternal smoking, parity, mode of delivery, gestation at delivery, sex- and gestation-specific birth weight centile, and 5-min Apgar score. SIMD, Scottish Index of Multiple Deprivation.

Figure 2

Poisson piecewise regression model of the risk of hospitalization over 5 years of follow-up from the first record of treatment by time from diagnosis and sex (A) and by age at admission and sex (▪, boys; ◇, girls) (B), adjusted for age, sex, deprivation quintile, ethnic group, maternal age, maternal smoking, parity, mode of delivery, gestation at delivery, sex- and gestation-specific birth weight centile, and 5-min Apgar score.