Educational and health outcomes of children treated for type 1 diabetes: Scotland-wide record linkage study of 766,047 children

Fleming, M. , Fitton, C. A., Steiner, M. F.C., McLay, J. S., Clark, D., King, A., Lindsay, R. , Mackay, D. F. and Pell, J. P. (2019) Educational and health outcomes of children treated for type 1 diabetes: Scotland-wide record linkage study of 766,047 children. Diabetes Care, 42(9), pp. 1700-1707. (doi:10.2337/dc18-2423) (PMID:31308017) (PMCID:PMC6706279)

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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, P < 0.001), 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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Lindsay, Dr Robert and Pell, Professor Jill and Mackay, Professor Daniel and Fleming, Dr Michael
Authors: Fleming, M., Fitton, C. A., Steiner, M. F.C., McLay, J. S., Clark, D., King, A., Lindsay, R., Mackay, D. F., and Pell, J. P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
Journal Name:Diabetes Care
Publisher:American Diabetes Association
ISSN:0149-5992
ISSN (Online):1935-5548
Copyright Holders:Copyright © 2019 American Diabetes Association
First Published:First published in Diabetes Care 42(9):1700-1707
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
3031970Linking education and health data together to study relationships between various health factors and children's educational and health outcomesJill PellMedical Research Council (MRC)MR/S003800/1HW - Public Health

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