Children with type 1 diabetes fare worse than peers in health, education
medwireNews: Children with type 1 diabetes have worse health outcomes and are more likely to miss school and have special educational needs than their nondiabetic peers, show results of a large study conducted in Scotland.
The record-linkage analysis of nine national databases included 766,047 singleton children born in Scotland who attended Scottish schools between 2009 and 2013. Of these, 3330 (0.47%) were receiving insulin for type 1 diabetes.
Michael Fleming (University of Glasgow, UK) and co-researchers report in Diabetes Care that, after adjustment for sociodemographic and maternal factors, the children with diabetes had a significant 3.97-fold increased risk for being admitted to hospital during the mean 4.3-year follow-up period and a 3.84-fold increased risk for death, despite a low number of deaths overall (n=490).
Of note, the magnitude of the association between diabetes and hospitalization risk was higher for boys than for girls and was greatest during the first year of insulin use.
Fleming and team also found that the children with diabetes had significantly more days absent from school each year (adjusted incidence rate ratio [IRR]=1.34) and were more likely to have a record of special educational need (adjusted odds ratio [OR]=2.45) than those without diabetes.
Further analysis showed that the significant association between type 1 diabetes and special educational needs was specific to learning difficulties (adjusted OR=1.19), physical motor disabilities (adjusted OR=1.55), and physical health conditions (adjusted OR=24.08). There were no associations with dyslexia, language or speech disorder, sensory impairment, autism spectrum disorder, social, emotional and behavioral difficulties, or mental health conditions.
In line with a Danish study previously reported by medwireNews, a subgroup analysis of 139,131 children who sat examinations during the study period revealed no significant association between type 1 diabetes and academic attainment, while a second analysis of 217,805 children showed that those with type 1 diabetes were no more likely to leave school before 16 years of age than their peers.
However, among children with type 1 diabetes, those with a mean glycated hemoglobin (HbA1c) in the highest quintile were a significant 3.52 times more likely to achieve just a low or basic level of academic attainment than children with a mean HbA1c in the lowest quintile, a finding that was also in line with the Danish data.
Children with the highest levels of HbA1c also had significantly more days absent from school each year (adjusted IRR=1.75), increased school exclusion (adjusted IRR=2.82), and were more likely to be unemployed 6 months after leaving school (adjusted OR=2.01) than those with the lowest HbA1c levels.
Based on their findings, Fleming et al conclude: “Interventions are required to try to minimize school absence and obviate any adverse effect of absences when they occur.”
By Laura Cowen
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