Impact of childhood-onset type 1 diabetes on schooling: A population-based register study

Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, 205 02, Malmö, Sweden, .
Diabetologia (Impact Factor: 6.67). 02/2013; 56(6). DOI: 10.1007/s00125-013-2870-8
Source: PubMed


We investigated the impact of type 1 diabetes on educational achievements in compulsory and upper secondary school, as well as potential long-lasting effects.

Altogether 2,485 individuals with type 1 diabetes, diagnosed at the age of <15 years and born in 1972-1978, were selected from the Swedish Childhood Diabetes Register, which was linked to national population registers including the Swedish Education Register. For each individual, four controls from the general population, matched for year of birth and residence at the time of diagnosis, were selected by Statistics Sweden (n = 9,940). We analysed the impact of diabetes on final school grades at 16 years (compulsory school) and 19 years (upper secondary school) and on participation in the labour market at 29 years using linear, logistic, ordered logistic and quantile regression analyses, controlling for demographics and socioeconomic background.

Diabetes had a negative effect on mean final grades (scale of 1-5) in compulsory school (-0.07, p < 0.001) and theoretical programmes in upper secondary school (-0.07, p = 0.001). Children with early-onset diabetes (0-4 years) suffered a greater disadvantage as a result of the disease (-0.15, p = 0.001 in compulsory school). The strongest effect was seen in the lowest deciles of the conditional distribution on mean final grades. At age 29, individuals with diabetes were less likely to be gainfully employed (OR 0.82, 95% CI 0.73, 0.91).

The small but significant negative effect of type 1 diabetes on schooling could affect opportunities for further education and career development. Attention must be paid in school to the special needs of children with diabetes.

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Available from: Katarina Steen Carlsson, Sep 02, 2014
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    • "Children are more sensitive to a lack of insulin than adults and are at higher risk of a rapid and dramatic development of diabetic ketoacidosis. Episodes of severe hypoglycaemia or ketoacidosis, especially in young children , are risk factors for structural brain abnormalities and impaired cognitive function which may cause schooling difficulties and limit future career choices [7] [8]. Even in developed countries there is still significant excess mortality among children and young adults with type 1 diabetes diagnosed in childhood. "
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    ABSTRACT: This paper describes the methodology, results and limitations of the 2013 International Diabetes Federation (IDF) Atlas (6th edition) estimates of the worldwide numbers of prevalent cases of type 1 diabetes in children (<15 years). The majority of relevant information in the published literature is in the form of incidence rates derived from registers of newly diagnosed cases. Studies were graded on quality criteria and, if no information was available in the published literature, extrapolation was used to assign a country the rate from an adjacent country with similar characteristics. Prevalence rates were then derived from these incidence rates and applied to United Nations 2012 Revision population estimates for 2013 for each country to obtain estimates of the number of prevalent cases. Data availability was highest for the countries in Europe (76%) and lowest for the countries in sub-Saharan Africa (8%). The prevalence estimates indicate that there are almost 500,000 children aged under 15 years with type 1 diabetes worldwide, the largest numbers being in Europe (129,000) and North America (108,700). Countries with the highest estimated numbers of new cases annually were the United States (13,000), India (10,900) and Brazil (5000). Compared with the prevalence estimates made in previous editions of the IDF Diabetes Atlas, the numbers have increased in most of the IDF Regions, often reflecting the incidence rate increases that have been well-documented in many countries. Monogenic diabetes is increasingly being recognised among those with clinical features of type 1 or type 2 diabetes as genetic studies become available, but population-based data on incidence and prevalence show wide variation due to lack of standardisation in the studies. Similarly, studies on type 2 diabetes in childhood suggest increased incidence and prevalence in many countries, especially in Indigenous peoples and ethnic minorities, but detailed population-based studies remain limited.
    Diabetes research and clinical practice 12/2013; 103(2). DOI:10.1016/j.diabres.2013.11.005 · 2.54 Impact Factor
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    ABSTRACT: Diabetes with onset in childhood and adolescence has consequences for the family and the child, and the negative health effects and burden of daily disease management are well known. Less is known about the socioeconomic consequences of the disease and how it impacts on school performance. In this issue of Diabetologia, Persson et al report from a Swedish study regarding the impact of childhood-onset type 1 diabetes on school performance (doi: 10.1007/s00125-013-2870-8 ). Results indicate that onset of type 1 diabetes in childhood has adverse effects on school achievement and potentially on future successful employment. The authors suggest that attention must be paid in school to the particular needs of children with diabetes, although the question needs to be raised as to whether the differences are of such a magnitude that they matter and are relevant for healthcare and school personnel. The study provides a novel addition and is important because of the limited information available on educational performance among children and adolescents with diabetes. However, the results should be interpreted with caution because of the limitations of the study design, the relatively small differences detected and the fact that results from one country are not transferable to other countries without further research. The challenge is to find the resources to set up population-based studies in countries where appropriate data are available to investigate the long-term effects of type 1 diabetes on education and employment in different settings.
    Diabetologia 04/2013; 56(6). DOI:10.1007/s00125-013-2900-6 · 6.67 Impact Factor
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    ABSTRACT: ABSTRACT Aim: To analyse how healthcare utilisation, healthcare costs and health-related quality of life (HRQoL) differ for individuals with diabetes compared to control individuals from the general population and how these differences are associated with disease duration and changes in the health care over time. A further aim was to explore diabetes care from an equity perspective. Methods: The research was based on four cohorts with disease durations of 1, 8, 15 or 24 years. These cohorts were selected from the Diabetes Incidence Study in Sweden, which registers all incident cases of diabetes in the age group 15 to 34 years, the majority Type 1 and insulin-treated. Control individuals were selected from the population register matched by age, sex and county of residence. In January 2008, a survey questionnaire was mailed by post to the 1983, 1992 and 1999 cohorts and their matching control groups. In 2009, the same survey questionnaire was quarterly sent to the 2008 cohort and to matching controls. The overall response rates were 54% (n=864) for individuals with diabetes and 51% (n=1616) for control individuals. Results: Higher utilisation of healthcare services by patients with diabetes compared to control individuals, and the necessary medication, led to an annual excess costs of 40 000 to 50 000 Swedish crowns per patient with no significant differences among the four cohorts. The costs of health care for women (in both the diabetes groups and the control groups) were almost double the costs for men in most cohorts. Living with diabetes had a negative impact on HRQoL and the difference to control individuals increased by disease duration for women with diabetes. However, there were no significant differences between individuals with diabetes 1 year after diagnosis and the control individuals, which may be related to good early management of diabetes care and an early adaptation to the disease. Compared to a previous study conducted in the early 1990s, excess costs increased mainly due to the greater use of insulin pumps and insulin analogues. Utilisation patterns for patients with diabetes were stable except for a significant decrease in hospital inpatient care 1 year after diagnosis (60% to 13%), and an increase in daycare 8 years after diagnosis (11% to 44%). The excess costs 1 year after diagnosis were similar whereas excess costs 8 years after diagnosis more than doubled, but while the largest proportion of costs in 2009 was for hospital outpatient care, 16 years earlier most costs were for hospital inpatient care. In line with the results from the previous study, the largest proportion of costs 8 years after diagnosis were attributable to insulin treatment and monitoring of blood glucose, followed by the costs for hospital outpatient care. Conclusions: Individuals with diabetes seem to lead rather unrestricted lives with less hospital inpatient care and a higher degree of self-management than 16 years earlier. However, the findings indicate that healthcare utilisation, costs and HRQoL vary by gender and socio-economic background. In addition to having diabetes, being a women, having a low education level or low income, and not being married all had a negative effect on almost all outcome measures addressed in this thesis. Utilisation patterns, costs and HRQoL can be described and analysed by continued health services research, and may be a valuable complement to more clinically oriented research. Health services research may also provide valuable information in the formulation of future healthcare policies. In contrast to randomised controlled trials, long-term studies of diabetes populations in real-world health systems can shed light on issues of access to the healthcare systems as well as on associated equity issues.
    08/2013, Degree: PhD, Supervisor: Rolf Wahlström, Kristina Burström, Pia Maria Jonsson, Lennarth Nyström, Jan Östman
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