Children with type 1 diabetes do not suffer academically
medwireNews: Type 1 diabetes has no significant impact on standardized test scores in mathematics and reading for children in grades 2 to 8, show results of a study of Danish public school children.
However, among children with diabetes, better glycemic control was associated with better test scores, report Niels Skipper (Aarhus University, Denmark) and co-authors in JAMA.
The study included 631,620 children (mean age 10.3 years, 51% boys) who were tested in reading in grades 2, 4, 6, and, 8 and in mathematics in grades 3 and 6. Of these, 2031 had type 1 diabetes of mean 4.5 years duration.
The researchers found that when the standardized test scores for reading and mathematics were combined, there was no significant difference between the children with and without diabetes, at a mean of 56.56 versus 56.11 on a scale of 1 to 100.
After adjustment for school grade, test subject, and calendar year (2011–2015), the estimated difference in test scores between the children with and without diabetes was 0.24. This increased to 0.45 with further adjustment for socioeconomic status.
Similar results were observed when the mathematics and reading scores were analyzed separately.
Among the children with diabetes, there was a significant interaction between glycated hemoglobin (HbA1c) level and test scores, whereby higher HbA1c was associated with poorer test scores.
Before adjustment, each 1% increase in HbA1c level was associated with a significant 3.48-point reduction in test score. After adjustment for grade, subject, year, and socioeconomic status, the same increase in HbA1c was associated with a nonsignificant 1.59-point reduction in test score.
Having diabetic ketoacidosis at diabetes onset, a diabetes diagnosis before 6 years of age, and a diabetes duration of more than 4 years did not significantly impact test scores.
Skipper and team point out that their finding of no difference in test scores between the children with and without diabetes differs from the results of previous studies.
They suggest: “It is possible that advances in treatment modalities over recent decades (64% of children with diabetes in this study used an insulin pump) have improved not only gaps in mortality and morbidity between individuals with diabetes and the overall population but also have improved gaps in school performance.”
However, researchers also note that “Denmark has considerable diabetes awareness and good medical and social care by international standards, and hence the findings may not apply to other countries.”
“It is possible that the gaps in test performance are larger in countries where access to health care is associated with socioeconomic status,” they add.
In line with this, Skipper et al conclude that their results highlight the importance of adjusting “for confounders such as socioeconomic status when assessing the association between diabetes control and test scores or school performance.”
By Laura Cowen
medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group