Peer-reviewed article
Educational and Health Outcomes of Children Treated for Type 1 Diabetes: Scotland-Wide Record Linkage Study of 766,047 Children
Michael Fleming, Catherine A. Fitton, Markus F. C. Steiner, James S. McLay, David Clark et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study linked nine Scotland-wide databases to compare health and education outcomes for 3,330 children with type 1 diabetes against 762,717 peers. Children with diabetes were significantly more likely to be hospitalised, die, miss school, and have learning difficulties. Poor blood sugar control (measured by HbA1c) was associated with even worse outcomes including school exclusion, lower academic attainment, and higher unemployment risk. The findings suggest that interventions to improve diabetes management and reduce school absence are needed.
Key points
- Children with type 1 diabetes had 3.97 times higher risk of hospital admission and 3.84 times higher mortality risk than peers
- Children with diabetes were 34% more likely to be absent from school and 19% more likely to have learning difficulties
- Among children with diabetes, those with the highest blood sugar levels (HbA1c in highest quintile) were 1.75 times more likely to be absent and 3.52 times more likely to have poor academic attainment
- Poor glycaemic control was associated with 2.82 times higher risk of school exclusion and 2.01 times higher unemployment risk
- Study included 766,047 children born in Scotland attending school 2009–2013
Limitations
This is an observational study using record linkage that can show associations but not prove causation; some outcomes (learning difficulties, unemployment) may be partly explained by factors not captured in the available databases. The study does not evaluate the effectiveness of specific interventions to address these disparities.
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 HbA1c (particularly HbA1c 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 HbA1c. Interventions are required to minimize school absence and ensure that it does not affect educational attainment.