Educational Attainment and Childhood-Onset Type 1 Diabetes

Objective To quantify associations between educational outcomes with type 1 diabetes status and glycaemic management (Hba1c). Research Design and Methods A record linkage study of schools and higher (college) education datasets linked to national diabetes audits. The population includes all Welsh children attending school between 2009 and 2016, yielding eight academic cohorts with attainment data, including 263,426 children without diabetes and 1,212 children diagnosed with type 1 diabetes. Outcomes include standardised student attainment aged 16 years, higher education participation aged 18 years, and school absences aged 6 to 16 years. Results Comparison between children with type 1 diabetes and children without diabetes showed no strong evidence of associations for student attainment (+0·001 SD, CI -0·047 to 0·049, p<0·96 n=1,212 vs 263,426) or higher education entry rates (OR=1·067, CI=0·919 to 1·239, p<0·39 n=965 vs 217,191), despite nine more sessions of absence from school annually (p<0·0001). However, attainment in children in the most optimal HbA1c quintile was substantially better than children without diabetes (+0·267 SD, CI 0·160 to 0·374, p<0·001) while being worse than children without diabetes in the least optimal quintile (-0·395 SD, CI -0·504 to -0·287, p<0·001). Attainment did not differ by duration of ‘exposure’ to diabetes based on age at diagnosis. Conclusions Despite greater school absences, being diagnosed with diabetes is not associated with educational attainment or entry into higher education, although attainment does vary by HbA1c levels, which may be explained in part (or wholly) by unobserved shared personal, family, or socioeconomic characteristics associated with both success in education and effective glycaemic self-management.