Associations between type 1 diabetes and educational outcomes: an Aotearoa/New Zealand nationwide birth cohort study using the Integrated Data Infrastructure

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Abstract

Aims/hypothesis

Type 1 diabetes is one of the most common chronic diseases of childhood. It is hypothesised that the metabolic and psychosocial consequences of type 1 diabetes may affect educational outcomes; however, existing literature presents conflicting results. This study aimed to assess whether educational outcomes differ for young people with and without type 1 diabetes in Aotearoa/New Zealand (NZ).

Methods

This was a nationwide 9 year birth cohort study of all people born in NZ from 1993 to 2001 using linked administrative data held within the Integrated Data Infrastructure, a national research database containing linked health and non-health data. Educational outcomes of high school attainment, high school attendance and university enrolment were measured from age 13 years until 20 years. Generalised linear regression models with log link and Gaussian distributions were used to compare educational outcomes between those with and those without type 1 diabetes, adjusting for sociodemographic and maternal characteristics.

Results

Of the 442,320 children in the birth cohort, type 1 diabetes was identified in 2058 (0.47%) (mean [SD] age of type 1 diabetes diagnosis 7.7 [3.4] years). Educational outcomes were significantly lower for children with type 1 diabetes than for those without type 1 diabetes, including for any high school qualification (RR 0.97 [95% CI 0.95, 0.99]), university entrance-level high school attainment (RR 0.88 [95% CI 0.84, 0.92]), regular high school attendance (RR 0.91 [95% CI 0.85, 0.97]) and university enrolment (RR 0.93 [95% CI 0.88, 0.98]), even after adjusting for sociodemographic and maternal factors. In addition, educational outcomes were substantially lower for those with post type 1 diabetes diagnosis hospitalisations for diabetic ketoacidosis and hypoglycaemia.

Conclusions/interpretation

In this whole NZ birth cohort study, type 1 diabetes was associated with lower educational outcomes spanning secondary school and into university enrolment. Ongoing efforts to support students with type 1 diabetes are needed, particularly for those with a greater risk profile.

Graphical Abstract

Supplementary Information

The online version contains peer-reviewed but unedited supplementary material available at 10.1007/s00125-023-06026-y.

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Most cited references 42

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The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus

S Genuth, C. Siebert, D. M. Nathan … (1993)

Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM). We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of these complications. A total of 1441 patients with IDDM--726 with no retinopathy at base line (the primary-prevention cohort) and 715 with mild retinopathy (the secondary-intervention cohort) were randomly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections. The patients were followed for a mean of 6.5 years, and the appearance and progression of retinopathy and other complications were assessed regularly. In the primary-prevention cohort, intensive therapy reduced the adjusted mean risk for the development of retinopathy by 76 percent (95 percent confidence interval, 62 to 85 percent), as compared with conventional therapy. In the secondary-intervention cohort, intensive therapy slowed the progression of retinopathy by 54 percent (95 percent confidence interval, 39 to 66 percent) and reduced the development of proliferative or severe nonproliferative retinopathy by 47 percent (95 percent confidence interval, 14 to 67 percent). In the two cohorts combined, intensive therapy reduced the occurrence of microalbuminuria (urinary albumin excretion of > or = 40 mg per 24 hours) by 39 percent (95 percent confidence interval, 21 to 52 percent), that of albuminuria (urinary albumin excretion of > or = 300 mg per 24 hours) by 54 percent (95 percent confidence interval 19 to 74 percent), and that of clinical neuropathy by 60 percent (95 percent confidence interval, 38 to 74 percent). The chief adverse event associated with intensive therapy was a two-to-threefold increase in severe hypoglycemia. Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.

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The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement

Eric Benchimol, Liam Smeeth, Astrid Guttmann … (2015)

Routinely collected health data, obtained for administrative and clinical purposes without specific a priori research goals, are increasingly used for research. The rapid evolution and availability of these data have revealed issues not addressed by existing reporting guidelines, such as Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement was created to fill these gaps. RECORD was created as an extension to the STROBE statement to address reporting items specific to observational studies using routinely collected health data. RECORD consists of a checklist of 13 items related to the title, abstract, introduction, methods, results, and discussion section of articles, and other information required for inclusion in such research reports. This document contains the checklist and explanatory and elaboration information to enhance the use of the checklist. Examples of good reporting for each RECORD checklist item are also included herein. This document, as well as the accompanying website and message board (http://www.record-statement.org), will enhance the implementation and understanding of RECORD. Through implementation of RECORD, authors, journals editors, and peer reviewers can encourage transparency of research reporting.

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Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange clinic registry.

Kellee Miller, Nicole C Foster, Roy Beck … (2015)

To examine the overall state of metabolic control and current use of advanced diabetes technologies in the U.S., we report recent data collected on individuals with type 1 diabetes participating in the T1D Exchange clinic registry. Data from 16,061 participants updated between 1 September 2013 and 1 December 2014 were compared with registry enrollment data collected from 1 September 2010 to 1 August 2012. Mean hemoglobin A1c (HbA1c) was assessed by year of age from 75 years. The overall average HbA1c was 8.2% (66 mmol/mol) at enrollment and 8.4% (68 mmol/mol) at the most recent update. During childhood, mean HbA1c decreased from 8.3% (67 mmol/mol) in 2-4-year-olds to 8.1% (65 mmol/mol) at 7 years of age, followed by an increase to 9.2% (77 mmol/mol) in 19-year-olds. Subsequently, mean HbA1c values decline gradually until ∼30 years of age, plateauing at 7.5-7.8% (58-62 mmol/mol) beyond age 30 until a modest drop in HbA1c below 7.5% (58 mmol/mol) in those 65 years of age. Severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) remain all too common complications of treatment, especially in older (SH) and younger patients (DKA). Insulin pump use increased slightly from enrollment (58-62%), and use of continuous glucose monitoring (CGM) did not change (7%). Although the T1D Exchange registry findings are not population based and could be biased, it is clear that there remains considerable room for improving outcomes of treatment of type 1 diabetes across all age-groups. Barriers to more effective use of current treatments need to be addressed and new therapies are needed to achieve optimal metabolic control in people with type 1 diabetes.

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Author and article information

Contributors

Benjamin J. Wheeler:

ORCID: http://orcid.org/0000-0003-3348-5238

ben.wheeler@otago.ac.nz

Journal

Journal ID (nlm-ta): Diabetologia

Journal ID (iso-abbrev): Diabetologia

Title: Diabetologia

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0012-186X

ISSN (Electronic): 1432-0428

Publication date (Electronic): 23 October 2023

Publication date PMC-release: 23 October 2023

Publication date (Print): 2024

Volume: 67

Issue: 1

Pages: 62-73

Affiliations

[1 ]Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, ( https://ror.org/01jmxt844) Dunedin, New Zealand

[2 ]A Better Start National Science Challenge, Auckland, New Zealand

[3 ]Faculty of Health, University of Canterbury, ( https://ror.org/03y7q9t39) Christchurch, New Zealand

[4 ]College of Education, University of Otago, ( https://ror.org/01jmxt844) Dunedin, New Zealand

[5 ]Department of Paediatrics, Te Whatu Ora/Health NZ, Christchurch, New Zealand

[6 ]Department of Paediatrics, University of Otago, ( https://ror.org/01jmxt844) Christchurch, New Zealand

[7 ]Department of Public Health, University of Otago, ( https://ror.org/01jmxt844) Wellington, New Zealand

[8 ]Centre for Pacific Health, Va’a O Tautai, Health Sciences Division, University of Otago, ( https://ror.org/01jmxt844) Dunedin, New Zealand

[9 ]Waikato Regional Diabetes Service, Hamilton, New Zealand

[10 ]Te Hutaki Waiora School of Health, University of Waikato, ( https://ror.org/013fsnh78) Hamilton, New Zealand

[11 ]Paediatric Endocrinology, Te Whatu Ora/Health NZ – Southern, Dunedin, New Zealand

Author information

Nicholas Bowden http://orcid.org/0000-0003-4589-9956

Rachael Dixon http://orcid.org/0000-0003-2468-7997

Vivienne Anderson http://orcid.org/0000-0002-2055-8998

Martin de Bock http://orcid.org/0000-0003-0454-6679

Alisa Boucsein http://orcid.org/0000-0002-6266-8802

Sheree Gibb http://orcid.org/0000-0002-9708-8816

Jesse Kokaua http://orcid.org/0000-0001-8740-1277

Ryan Paul http://orcid.org/0000-0002-1579-3870

Barry Taylor http://orcid.org/0000-0002-6450-8677

Hien Vu http://orcid.org/0009-0002-6250-6202

Benjamin J. Wheeler http://orcid.org/0000-0003-3348-5238

Article

Publisher ID: 6026

DOI: 10.1007/s00125-023-06026-y

PMC ID: 10709242

PubMed ID: 37870651

SO-VID: 47e51487-ee7f-4388-8ac9-644d176eb872

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 28 March 2023

Date accepted : 31 August 2023

Funding

Funded by: New Zealand Ministry of Business, Innovation and Employment

Award ID: UOAX1901

Funded by: FundRef http://dx.doi.org/10.13039/501100001505, Health Research Council of New Zealand;

Award ID: 21/1033

Funded by: FundRef http://dx.doi.org/10.13039/501100001515, Cure Kids;

Award ID: 3616

Funded by: University of Otago

Open Access :

Open Access funding enabled and organized by CAUL and its Member Institutions

Custom metadata

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: education,equity,paediatrics,school performance,type 1 diabetes

Data availability:

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: education, equity, paediatrics, school performance, type 1 diabetes

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Associations between type 1 diabetes and educational outcomes: an Aotearoa/New Zealand nationwide birth cohort study using the Integrated Data Infrastructure

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Journal of the ASEAN Federation of Endocrine Societies

Most cited references 42

The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus

The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement

Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange clinic registry.

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