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Pedersen MJ, Høst C, Hansen SN, Klotsche J, Minden K, Deleuran BW, Bech BH. School Well-Being and Academic Performance of Children With Juvenile Idiopathic Arthritis: A National Register-Based Study. J Rheumatol 2024; 51:804-810. [PMID: 38561185 DOI: 10.3899/jrheum.2023-1197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE We aimed to investigate how school well-being (SWB) and academic performance of children with juvenile idiopathic arthritis (JIA) compare to their peers on a national level using the Danish national registers. Further, we investigated the potential influence of socioeconomic status (SES). METHODS A population-wide, register-based, cross-sectional study was performed. We compared the results of children with and without JIA in the Danish National Well-Being Questionnaire (DNWQ), the National Danish School Testing (NDST), and their ninth grade (aged approximately 16 yrs) final school marks in Danish and mathematics. The results were analyzed using adjusted ordinal logistic regression (SWB) and linear regression (tests and marks). RESULTS In separate cohorts, we included a total of 505,340 children answering the DNWQ, 812,461 children with NDST results, and the ninth-grade final marks of 581,804 children. Of these children, 1042, 1541, and 1410, respectively, fulfilled the criteria of JIA. Children with JIA reported SWB comparable to their peers, except for the question "Do you perform well in school?" (odds ratio 0.89, 95% CI 0.81-0.99). In the NDST, the children with JIA in general did just as well as their peers. We found no differences in the ninth-grade final marks in either Danish or mathematics. Stratifying the analyses on SES showed no significant differences in the associations. CONCLUSION Overall, children with JIA report SWB comparable to that of children without JIA and perform equally well in school as children without JIA.
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Affiliation(s)
- Malthe J Pedersen
- M.J. Pedersen, MD, S.N. Hansen, PhD, Department of Public Health, Aarhus University, Aarhus, Denmark;
| | - Christian Høst
- C. Høst, MD, PhD, Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Stefan Nygaard Hansen
- M.J. Pedersen, MD, S.N. Hansen, PhD, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jens Klotsche
- J. Klotsche, PhD, Epidemiology Unit, Deutsches Rheuma-Forschungszentrum, Berlin, Germany
| | - Kirsten Minden
- K. Minden, MD, Epidemiology Unit, Deutsches Rheuma-Forschungszentrum, and Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bent W Deleuran
- B.W. Deleuran, MD, Department of Rheumatology, and Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Bodil H Bech
- B.H. Bech, MD, PhD, Department of Public Health, Aarhus University, Aarhus, Denmark
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Ride J, Cameron L, Jones R, Hall T, Cameron F, White M. Participation and psychosocial supports in the school setting for children with type 1 diabetes: A discrete choice experiment of carer priority. Diabetes Res Clin Pract 2024; 213:111753. [PMID: 38906333 DOI: 10.1016/j.diabres.2024.111753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/14/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024]
Abstract
School-based diabetes care is an important consideration for clinicians and families alike. This Discrete-Choice Experiment describes parental preference for enhanced psychosocial and activity-focused supports over academic supports for children with Type 1 diabetes in Australian primary and secondary schools.
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Affiliation(s)
- Jemimah Ride
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Lachlan Cameron
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Renee Jones
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Health Services Research Unit, The Royal Children's Hospital, Parkville, Melbourne, Australia
| | - Teresa Hall
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Health Services Research Unit, The Royal Children's Hospital, Parkville, Melbourne, Australia
| | - Fergus Cameron
- Department of Endocrinology & Diabetes, The Royal Children's Hospital, Parkville, Melbourne, Australia; Diabetes Research, Murdoch Children's Research Institute, Parkville, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Australia
| | - Mary White
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Health Services Research Unit, The Royal Children's Hospital, Parkville, Melbourne, Australia; Department of Endocrinology & Diabetes, The Royal Children's Hospital, Parkville, Melbourne, Australia; Diabetes Research, Murdoch Children's Research Institute, Parkville, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Australia.
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Hjulmand AH, Trabjerg BB, Dreier JW, Christensen J. Utility of data from the Danish National School Test Program for health research purposes: Content and associations with sociodemographic factors and higher education. PLoS One 2024; 19:e0302472. [PMID: 38691564 PMCID: PMC11062538 DOI: 10.1371/journal.pone.0302472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/04/2024] [Indexed: 05/03/2024] Open
Abstract
The Danish National School Test Program is a set of nationwide tests performed annually since 2010 in all public schools in Denmark. To assess the utility of this data resource for health research purposes, we examined the association of school test performance with demographic and socioeconomic characteristics as well as correlations with ninth-grade exams and higher educational attainment. This nationwide descriptive register-based study includes children born between 1994 and 2010 who lived in Denmark at the age of six years. Norm-based test scores (range 1-100, higher scores indicate better performance) in reading (Danish) and mathematics from the Danish National School Test Program were obtained for children aged 6-16 attending public schools in Denmark from 2010 to 2019. Population registers were used to identify relevant demographic and socioeconomic variables. Mean test scores by demographic and socioeconomic variables were estimated using linear regression models. Among the full Danish population of 1,137,290 children (51.3% male), 960,450 (84.5%) children attended public schools. There were 885,360 children who completed one or more tests in reading or mathematics (test participation was 77.8% for the entire population, and 92.1% for children in public schools). Mean test scores varied by demographic and socioeconomic characteristics, most notably with education and labour market affiliation of parents. For every 1-point decrease in the test scores, there was a 0.95% (95% CI: 0.93%; 0.97%) lower probability of scoring B or higher in the ninth-grade exam and a 1.03% (95% CI: 1.00%; 1.05%) lower probability of completing high school within five years after graduating from lower secondary school. In this study of schoolchildren in Denmark, demographic and socioeconomic characteristics were associated with test scores from the Danish National School Test Program. Performance in school tests correlated closely with later educational attainment, suggesting that these early measures of school performance are good markers of subsequent academic potential.
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Affiliation(s)
- Anders H. Hjulmand
- National Centre for Register-Based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Betina B. Trabjerg
- National Centre for Register-Based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Julie W. Dreier
- National Centre for Register-Based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Thorsted AB, Thygesen LC, Hoffmann SH, Rosenkilde S, Lehn SF, Lundby-Christensen L, Horsbøl TA. Educational outcomes and the role of comorbidity among adolescents with type 1-diabetes in Denmark. Diabet Med 2024; 41:e15270. [PMID: 38173089 DOI: 10.1111/dme.15270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/01/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024]
Abstract
AIMS To examine educational outcomes among adolescents with type 1 diabetes and determine the role of comorbidity. METHODS We conducted a nationwide register-based cohort study including 3370 individuals born between 1991 and 2003 and diagnosed with type 1 diabetes before the age of 16. They were all matched with up to four individuals without type 1 diabetes on age, gender, parents' educational level and immigration status. Information on comorbidity was based on hospital diagnoses. The individuals were followed in registers to determine whether they finished compulsory school (9th grade, usually at the age of 15-16 years), and were enrolled in secondary education by age 18 years. RESULTS Individuals with type 1 diabetes were more likely not to complete compulsory school (OR 1.44, 95% CI 1.26-1.64), and not being enrolled in an upper secondary education by age 18 (OR 1.50, 95% CI 1.31-1.73) compared to their peers. A total of 1869 (56%) individuals with type 1 diabetes were registered with at least one somatic (n = 1709) or psychiatric comorbidity (n = 389). Those with type 1 diabetes and psychiatric comorbidity were more likely not to complete compulsory school (OR 2.47, 95% CI 1.54-3.96), and not being enrolled in an upper secondary education by age 18 (OR 3.66, 95% CI 2.27-5.91) compared to those with type 1 diabetes only. Further, there was a tendency towards an association between having somatic comorbidity and adverse educational outcomes (OR 1.25, 95% CI 0.97-1.63; OR 1.26, 95% CI 0.95-1.66) among adolescents with type 1 diabetes. The associations differed markedly between diagnostic comorbidity groups. CONCLUSION Type 1 diabetes affects educational attainment and participation among adolescents. Psychiatric comorbidity contributes to adverse educational outcomes in this group, and there is a tendency that somatic comorbidity also plays a role.
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Affiliation(s)
- Anne Bonde Thorsted
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Sofie Have Hoffmann
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Siri Rosenkilde
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Sara Fokdal Lehn
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Steno Diabetes Center Sjaelland, Holbæk, Denmark
| | - Louise Lundby-Christensen
- Department of Pediatrics and Adolescents Medicine, Amager and Hvidovre University Hospital, Hvidovre, Denmark
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Dreier JW, Trabjerg BB, Plana-Ripoll O, Skipper N, Agerbo E, Cotsapas C, Berg AT, Christensen J. Epilepsy in childhood and school performance: a nation-wide cohort study. Brain 2024; 147:532-541. [PMID: 38102964 DOI: 10.1093/brain/awad382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/26/2023] [Indexed: 12/17/2023] Open
Abstract
Childhood epilepsy has been linked to poor academic performance, but large-scale studies are lacking. In this nation-wide study of school-aged children, we examined the association between childhood epilepsy and school performance in standardized tests according to phenotypic and treatment-related characteristics. We performed a matched register-based cohort study of children born in Denmark (1997-2009) who participated in the Danish National School Test Programme between 2010 and 2019. We used population and health registers to identify children with epilepsy and a randomly sampled sex- and age-matched reference cohort without epilepsy (ratio 1:10). Norm-based test scores from language and mathematics reflecting performance as a percentile of the nation-wide distribution of scores (scale 1-100) were used to assess academic performance. Adjusted differences in mean standardized scores between children with and without epilepsy were estimated using linear regression models. Among 582 840 children participating in the School Test Programme, we identified 4659 (0.8%) children with epilepsy (52.8% males) and 46 590 matched reference children. Median age at epilepsy onset was 7.5 years (interquartile range: 4.0-10.6). Childhood epilepsy was associated with poorer school performance overall (mean score = 48.2 versus references = 56.7; adjusted difference = -6.7, 95% CI: -7.4 to -6.0), and worse performance was found in all epilepsy subgroups, including in 3534 children with uncomplicated epilepsy (i.e. no other pre-existing neurologic or intellectual disabilities and no identified possible cause for epilepsy; adjusted difference = -6.0, 95% CI: -6.8 to -5.2). No major variation by sex, age or subject was observed, but larger score differences were seen in children using antiseizure medication at time of testing (e.g. valproate monotherapy, adjusted difference = -9.3, 95% CI: -11.5 to -7.0 and lamotrigine monotherapy, adjusted difference = -13.1, 95% CI: -15.0 to -11.3) and in children with psychiatric comorbidity, especially epilepsy with comorbid intellectual disability (adjusted difference = -27.0, 95% CI: -30.0 to -23.9) and epilepsy with comorbid attention deficit/hyperactivity disorder (adjusted difference = -15.7, 95% CI: -19.0 to -12.4). Children with epilepsy scored significantly lower than their unaffected siblings (adjusted difference = -6.2, 95% CI: -7.1 to -5.4). In conclusion, childhood epilepsy was associated with impaired academic performance throughout schooling, which suggest that there is a widespread need for educational support of children with epilepsy, even when the child has no other comorbidities and when the epilepsy appears well-managed.
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Affiliation(s)
- Julie W Dreier
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway
| | - Betina B Trabjerg
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Niels Skipper
- Department of Economics and Business Economics, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
| | - Esben Agerbo
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
| | - Chris Cotsapas
- Department of Neurology, Yale, New Haven, CT 06510, USA
- Department of Genetics, Yale, New Haven, CT 06510, USA
| | - Anne T Berg
- Department of Neurology, Northwestern University - Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Jakob Christensen
- Department of Neurology, Affiliated Member of the European Reference Network EpiCARE, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
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Berot A, Morsa M, De Andrade V, Gagnayre R, Bihan H. Lack of consideration of socioeconomic factors in transition programme of adolescents with type 1 diabetes: A systematic review. Diabet Med 2024; 41:e15225. [PMID: 37714193 DOI: 10.1111/dme.15225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/17/2023]
Abstract
The transition of adolescents with type 1 diabetes should be organized such that loss of follow-up and deterioration of patients' metabolic control are minimized. OBJECTIVE Our study aimed to ascertain whether socioeconomic status is featured in the characteristics of adolescents with type 1 diabetes in transition programmes and their inclusion in transition programmes. RESEARCH DESIGN AND METHODS A systematic review of the literature was performed according to PRISMA recommendations. All articles published between 2010 and 2023 were considered. Studies that described a transition programme for adolescents or young adults with T1DM were included. RESULTS After screening, 18 studies were included. Different transition programmes were proposed (exchanges between professionals, coordinators, and transition clinics). Nine articles described socio-economic factors. The educational level was the most frequently reported. Only three studies evaluated the impact of one parameter on transition success: a lower education level was associated with more hospital visits for hyperglycaemia, and the other did not report any socioeconomic factor associated with clinic attendance. CONCLUSIONS The socioeconomic status of type 1 diabetes is poorly described in transition programmes, and the few that do make mention of it, offer little information about patient management.
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Affiliation(s)
- Aurelie Berot
- CHU Reims - American Memorial Hospital - Pediatrics, Reims, France
- University Sorbonne Paris Nord, Laboratoire Éducations et Promotion de la Santé, LEPS, Villetaneuse, France
| | - Maxime Morsa
- University Sorbonne Paris Nord, Laboratoire Éducations et Promotion de la Santé, LEPS, Villetaneuse, France
| | - Vincent De Andrade
- University Sorbonne Paris Nord, Laboratoire Éducations et Promotion de la Santé, LEPS, Villetaneuse, France
| | - Remi Gagnayre
- University Sorbonne Paris Nord, Laboratoire Éducations et Promotion de la Santé, LEPS, Villetaneuse, France
| | - Hélène Bihan
- University Sorbonne Paris Nord, Laboratoire Éducations et Promotion de la Santé, LEPS, Villetaneuse, France
- Endocrinology, Diabetology, Nutrition, Avicenne Hospital, APHP, Bobigny, France
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Bowden N, Dixon R, Anderson V, de Bock M, Boucsein A, Kewene-Edwards M, Gibb S, Kokaua J, Palmer O, Paul R, Taylor B, Vu H, Wheeler BJ. Associations between type 1 diabetes and educational outcomes: an Aotearoa/New Zealand nationwide birth cohort study using the Integrated Data Infrastructure. Diabetologia 2024; 67:62-73. [PMID: 37870651 PMCID: PMC10709242 DOI: 10.1007/s00125-023-06026-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/31/2023] [Indexed: 10/24/2023]
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.
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Affiliation(s)
- Nicholas Bowden
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- A Better Start National Science Challenge, Auckland, New Zealand
| | - Rachael Dixon
- Faculty of Health, University of Canterbury, Christchurch, New Zealand
| | | | - Martin de Bock
- Department of Paediatrics, Te Whatu Ora/Health NZ, Christchurch, New Zealand
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Alisa Boucsein
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Sheree Gibb
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jesse Kokaua
- Centre for Pacific Health, Va'a O Tautai, Health Sciences Division, University of Otago, Dunedin, New Zealand
| | - Octavia Palmer
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ryan Paul
- Waikato Regional Diabetes Service, Hamilton, New Zealand
- Te Hutaki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | - Barry Taylor
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- A Better Start National Science Challenge, Auckland, New Zealand
| | - Hien Vu
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
- Paediatric Endocrinology, Te Whatu Ora/Health NZ - Southern, Dunedin, New Zealand.
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8
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Liu S, Ludvigsson JF, Lichtenstein P, Gudbjörnsdottir S, Taylor MJ, Larsson H, Kuja-Halkola R, Butwicka A. Educational Outcomes in Children and Adolescents With Type 1 Diabetes and Psychiatric Disorders. JAMA Netw Open 2023; 6:e238135. [PMID: 37052917 PMCID: PMC10102872 DOI: 10.1001/jamanetworkopen.2023.8135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Importance Research shows that children and adolescents with type 1 diabetes (T1D), compared with their peers without diabetes, have a greater risk of psychiatric disorders. However, no study has comprehensively examined whether having psychiatric disorders is associated with educational outcomes in children and adolescents with T1D. Objective To investigate educational outcomes in children and adolescents with T1D with and without psychiatric disorders. Design, Setting, and Participants This cohort study used data from multiple Swedish registers. The main study cohort included individuals born in Sweden between January 1, 1973, and December 31, 1997, who were followed up from birth through December 31, 2013. Data analyses were conducted from March 1 to June 30, 2022. Exposures Type 1 diabetes and psychiatric disorders (including neurodevelopmental disorders, depression, anxiety disorders, eating disorders, bipolar disorder, psychotic disorder, and substance misuse) diagnosed before 16 years of age. Main Outcomes and Measures Achieving educational milestones (completing compulsory school [primary and lower secondary education], being eligible to and finishing upper secondary school, and starting and finishing university) and compulsory school performances. Results Of 2 454 862 individuals (51.3% male), 13 294 (0.5%; 53.9% male) were diagnosed with T1D (median [IQR] age at diagnosis, 9.5 [6.0-12.5] years), among whom 1012 (7.6%) also had at least 1 psychiatric disorder. Compared with healthy individuals (without T1D and psychiatric disorders), individuals with T1D alone had slightly lower odds of achieving the examined educational milestones. However, those with both T1D and any psychiatric disorder had much lower odds of achieving milestones, including completing compulsory school (odds ratio [OR], 0.17; 95% CI, 0.13-0.21), being eligible for (OR, 0.25; 95% CI, 0.21-0.30) and finishing (OR, 0.19; 95% CI, 0.14-0.26) upper secondary school, and starting (OR, 0.36; 95% CI, 0.29-0.46) and finishing (OR, 0.30; 95% CI, 0.20-0.47) university. They also showed lower grade point averages for compulsory school subjects. These findings remained similar in sibling comparison analyses, suggesting independence from familial confounding. Conclusions and Relevance In this cohort study of Swedish-born children and adolescents, those with T1D alone had minor difficulties with their educational outcomes, whereas those with both T1D and psychiatric disorders had universal long-term educational underachievement. These findings highlight the importance of identifying psychiatric disorders in pediatric patients with T1D and the need for targeted educational intervention and support to minimize the education gap between the affected children and their peers.
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Affiliation(s)
- Shengxin Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Soffia Gudbjörnsdottir
- Swedish National Diabetes Register, Centre of Registers, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mark J Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Agnieszka Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Sweden
- Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
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9
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El Kantar Y, Durán S, Lanes R, Paoli M. Evaluación del desempeño cognitivo en escolares y adolescentes con diabetes mellitus tipo 1. INVESTIGACIÓN CLÍNICA 2023. [DOI: 10.54817/ic.v64n1a03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
The study aimedto evaluate the cognitive functioning of children and adolescents with type 1 diabetes mellitus (T1DM) recruited from the IAHULA Endocrinology Outpatient Unit and to compare it to that of non-diabetics as to investigate the influence on cognition of factors re-lated to the disease. An analytical, cross-sectional observational study was carried out on a group of 30 patients with T1DM between 8 and 16 years of age and on a control group of 30 individuals matched by age, gender, education, and socioeconomic status. Interrogation and review of medi-cal records to obtain data on the clinical characteristics and treatment of T1DM were conducted. The WISC IV test was then applied to evaluate cognition and intellectual coefficient (IQ). The average age of the diabetic patients was 13.27±2.31 years, and half of them were male. Lower scores were found in the different domains of the WISC IV in the group with T1DM (p<0.01). The IQ was found to be lower in children with T1DM than in con-trols (75.47±13.87 vs. 88.57±11.06; p=0.0001). Likewise, a higher fre-quency of IQ scores below the 10th percentile was observed in the diabetic children (63.3% vs. 33.3%; p=0.02; Odds ratio: 3.45; 95%CI: 1.19-9.99). It was concluded that T1DM negatively impacts the cognitive performance of children and adolescents. Cognitive evaluation of these patients is recom-mended, as it could affect their daily life.
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Affiliation(s)
- Yusmary El Kantar
- Servicio de Endocrinología del Instituto Autónomo Hospital Universitario de Los Andes (IAHULA), Mérida, Venezuela
| | - Samy Durán
- Oficina Estadal Antidrogas, Mérida, Venezuela
| | - Roberto Lanes
- Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
| | - Mariela Paoli
- Servicio de Endocrinología del Instituto Autónomo Hospital Universitario de Los Andes (IAHULA), Mérida, Venezuela
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10
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de Wit M, Gajewska KA, Goethals ER, McDarby V, Zhao X, Hapunda G, Delamater AM, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Psychological care of children, adolescents and young adults with diabetes. Pediatr Diabetes 2022; 23:1373-1389. [PMID: 36464988 PMCID: PMC10107478 DOI: 10.1111/pedi.13428] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Maartje de Wit
- Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Psychology, Amsterdam Public Health, Amsterdam, Netherlands
| | - Katarzyna A Gajewska
- Diabetes Ireland, Dublin, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | | | | | - Xiaolei Zhao
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Given Hapunda
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Linda A DiMeglio
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA
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11
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French R, Kneale D, Warner JT, Robinson H, Rafferty J, Sayers A, Taylor P, Gregory JW, Dayan CM. Educational Attainment and Childhood-Onset Type 1 Diabetes. Diabetes Care 2022; 45:2852-2861. [PMID: 36455114 DOI: 10.2337/dc21-0693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/24/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To quantify associations of educational outcomes with type 1 diabetes status and glycemic management (HbA1c). RESEARCH DESIGN AND METHODS This was a record linkage study of schools and higher (college) education data sets 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 standardized educational attainment for those aged 16 years, higher education participation for those aged ≥18 years, and school absences among those aged 6-16 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, 95% CI -0.047 to 0.049, P < 0.96, n = 1,212 vs. 263,426) or higher education entry rates (odds ratio 1.067, 95% CI 0.919-1.239, 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 for children without diabetes (0.267 SD, 95% CI 0.160-0.374, P < 0.001) while being worse than for children without diabetes in the least optimal quintile (-0.395 SD, 95% 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 more school absences, diabetes diagnosis is not associated with educational attainment or entry into higher education, although attainment does vary by HbA1c level, which may be explained in part (or wholly) by unobserved shared personal, family, or socioeconomic characteristics associated with both success in education and effective glycemic self-management.
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Affiliation(s)
- Robert French
- Diabetes Research Group, Division of Infection and Immunity, School of Medicine, Cardiff University, Heath Park, Cardiff, U.K
| | - Dylan Kneale
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Research Institute, University College London, London, U.K
| | - Justin T Warner
- Noah's Ark Children's Hospital for Wales, Cardiff and Vale University Health Board, Heath Park, Cardiff, U.K
| | - Holly Robinson
- Royal College of Paediatrics and Child Health, London, U.K
| | | | | | - Peter Taylor
- Diabetes Research Group, Division of Infection and Immunity, School of Medicine, Cardiff University, Heath Park, Cardiff, U.K
| | - John W Gregory
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, U.K
| | - Colin M Dayan
- Diabetes Research Group, Division of Infection and Immunity, School of Medicine, Cardiff University, Heath Park, Cardiff, U.K
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12
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Lanzinger S, Zimmermann A, Ranjan AG, Gani O, Pons Perez S, Akesson K, Majidi S, Witsch M, Hofer S, Johnson S, Pilgaard KA, Kummernes SJ, Robinson H, Eeg-Olofsson K, Ebekozien O, Holl RW, Svensson J, Skrivarhaug T, Warner J, Craig ME, Maahs D. A collaborative comparison of international pediatric diabetes registries. Pediatr Diabetes 2022; 23:627-640. [PMID: 35561091 DOI: 10.1111/pedi.13362] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/24/2022] [Accepted: 05/04/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND An estimated 1.1 million children and adolescents aged under 20 years have type 1 diabetes worldwide. Principal investigators from seven well-established longitudinal pediatric diabetes registries and the SWEET initiative have come together to provide an international collaborative perspective and comparison of the registries. WORK FLOW Information and data including registry characteristics, pediatric participant clinical characteristics, data availability and data completeness from the Australasian Diabetes Data Network (ADDN), Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids), Diabetes prospective follow-up registry (DPV), Norwegian Childhood Diabetes Registry (NCDR), National Paediatric Diabetes Audit (NPDA), Swedish Childhood Diabetes Registry (Swediabkids), T1D Exchange Quality Improvement Collaborative (T1DX-QI), and the SWEET initiative was extracted up until 31 December 2020. REGISTRY OBJECTIVES AND OUTCOMES The seven diabetes registries and the SWEET initiative collectively show data of more than 900 centers and around 100,000 pediatric patients, the majority with type 1 diabetes. All share the common objectives of monitoring treatment and longitudinal outcomes, promoting quality improvement and equality in diabetes care and enabling clinical research. All generate regular benchmark reports. Main differences were observed in the definition of the pediatric population, the inclusion of adults, documentation of CGM metrics and collection of raw data files as well as linkage to other data sources. The open benchmarking and access to regularly updated data may prove to be the most important contribution from registries. This study describes aspects of the registries to enable future collaborations and to encourage the development of new registries where they do not exist.
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Affiliation(s)
- Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany.,German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | | | - Ajenthen G Ranjan
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | - Osman Gani
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Karin Akesson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden
| | - Shideh Majidi
- University of Colorado, Barbara Davis Center, Aurora, Colorado, USA
| | - Michael Witsch
- Department of Pediatrics DECCP, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Sabine Hofer
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Kasper A Pilgaard
- Department of Pediatrics and Adolescents, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Siv Janne Kummernes
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Holly Robinson
- Royal College of Paediatrics and Child Health, London, UK
| | - Katarina Eeg-Olofsson
- Swedish National Diabetes Register, Centre of Registers, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Osagie Ebekozien
- T1D Exchange, Boston, Massachusetts, USA.,University of Mississippi School of Population Health, Jackson, Mississippi, USA
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany.,German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Jannet Svensson
- Department of Pediatrics and Adolescents, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torild Skrivarhaug
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Maria E Craig
- Charles Perkins Centre Westmead, University of Sydney, Australia.,The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,University of NSW, Sydney, New South Wales, Australia
| | - David Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA.,Stanford Diabetes Research Center, Stanford, California, USA
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13
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The educational burden of disease: a cohort study. THE LANCET PUBLIC HEALTH 2022; 7:e549-e556. [DOI: 10.1016/s2468-2667(22)00059-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 01/05/2023] Open
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14
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Mitchell RJ, McMaugh A, Woodhead H, Lystad RP, Zurynski Y, Badgery‐Parker T, Cameron CM, Hng T. The impact of type 1 diabetes mellitus in childhood on academic performance: A matched population-based cohort study. Pediatr Diabetes 2022; 23:411-420. [PMID: 35080102 PMCID: PMC9306722 DOI: 10.1111/pedi.13317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/30/2021] [Accepted: 01/18/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The impact of type 1 diabetes mellitus (T1D) on academic performance is inconclusive. This study aims to compare scholastic performance and high-school completion in young people hospitalized with T1D compared to matched peers not hospitalized with diabetes. RESEARCH DESIGN Retrospective case-comparison cohort study. METHOD A population-level matched case-comparison study of people aged ≤18 hospitalized with T1D during 2005-2018 in New South Wales, Australia using linked health-related and education records. The comparison cohort was matched on age, gender, and residential postcode. Generalized linear mixed modeling examined risk of school performance below the national minimum standard (NMS) and generalized linear regression examined risk of not completing high school for young people hospitalized with T1D compared to peers. Adjusted relative risks (ARR) were calculated. RESULTS Young females and males hospitalized with T1D did not have a higher risk of not achieving the NMS compared to peers for numeracy (ARR: 1.19; 95%CI 0.77-1.84 and ARR: 0.74; 95%CI 0.46-1.19) or reading (ARR: 0.98; 95%CI 0.63-1.50 and ARR: 0.85; 95%CI 0.58-1.24), respectively. Young T1D hospitalized females had a higher risk of not completing year 11 (ARR: 1.73; 95%CI 1.19-2.53) or 12 (ARR: 1.65; 95%CI 1.17-2.33) compared to peers, while hospitalized T1D males did not. CONCLUSIONS There was no difference in academic performance in youth hospitalized with T1D compared to peers. Improved glucose control and T1D management may explain the absence of school performance decrements in students with T1D. However, females hospitalized with T1D had a higher risk of not completing high school. Potential associations of this increased risk, with attention to T1D and psycho-social management, should be investigated.
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Affiliation(s)
- Rebecca J. Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNSWAustralia
| | - Anne McMaugh
- The Macquarie School of EducationMacquarie UniversitySydneyNSWAustralia
| | - Helen Woodhead
- School of Women's and Children's Health, Faculty of MedicineUniversity of New South WalesSydneyNSWAustralia,Department of Paediatric Diabetes and EndocrinologyRoyal North Shore HospitalSydneyNSWAustralia,Department of Endocrinology and DiabetesSydney Children's HospitalSydneyNSWAustralia
| | - Reidar P. Lystad
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNSWAustralia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNSWAustralia
| | - Tim Badgery‐Parker
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNSWAustralia
| | - Cate M. Cameron
- Jamieson Trauma InstituteRoyal Brisbane & Women's Hospital, Metro North Hospital and Health Services DistrictBrisbaneQLDAustralia,Centre for Healthcare Transformation, Australian Centre for Health Services InnovationQueensland University of TechnologyBrisbaneQLDAustralia
| | - Tien‐Ming Hng
- Department of Diabetes and EndocrinologyBlacktown and Mount Druitt HospitalSydneyNSWAustralia,School of MedicineWestern Sydney UniversitySydneyNSWAustralia
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15
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Spangmose AL, Skipper N, Knorr S, Wullum Gundersen T, Beck Jensen R, Damm P, Lykke Mortensen E, Pinborg A, Svensson J, Clausen T. School performance in Danish children exposed to maternal type 1 diabetes in utero: A nationwide retrospective cohort study. PLoS Med 2022; 19:e1003977. [PMID: 35472047 PMCID: PMC9041831 DOI: 10.1371/journal.pmed.1003977] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/29/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Conflicting results have been reported concerning possible adverse effects on the cognitive function of offspring of mothers with type 1 diabetes (O-mT1D). Previous studies have included offspring of parents from the background population (O-BP), but not offspring of fathers with type 1 diabetes (O-fT1D) as the unexposed reference group. METHODS AND FINDINGS This is a population-based retrospective cohort study from 2010 to 2016. Nationally standardized school test scores (range, 1 to 100) were obtained for public school grades 2, 3, 4, 6, and 8 in O-mT1D and compared with those in O-fT1D and O-BP. Of the 622,073 included children, 2,144 were O-mT1D, and 3,474 were O-fT1D. Multiple linear regression models were used to compare outcomes, including the covariates offspring with type 1 diabetes, parity, number of siblings, offspring sex, smoking during pregnancy, parental age, and socioeconomic factors. Mean test scores were 54.2 (standard deviation, SD 24.8) in O-mT1D, 54.4 (SD 24.8) in O-fT1D, and 56.4 (SD 24.7) in O-BP. In adjusted analyses, the mean differences in test scores were -1.59 (95% CI -2.48 to -0.71, p < 0.001) between O-mT1D and O-BP and -0.78 (95% CI -1.48 to -0.08, p = 0.03) between O-fT1D and O-BP. No significant difference in the adjusted mean test scores was found between O-mT1D and O-fT1D (p = 0.16). The study's limitation was no access to measures of glycemic control during pregnancy. CONCLUSIONS O-mT1D achieved lower test scores than O-BP but similar test scores compared with O-fT1D. Glycemic control during pregnancy is essential to prevent various adverse pregnancy outcomes in women with type 1 diabetes. However, the present study reduces previous concerns regarding adverse effects of in utero hyperglycemia on offspring cognitive function.
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Affiliation(s)
- Anne Lærke Spangmose
- Fertility Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| | - Niels Skipper
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Sine Knorr
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | | | - Rikke Beck Jensen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Denmark
| | - Anja Pinborg
- Fertility Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jannet Svensson
- Department of Paediatric and Adolescents, Copenhagen University Hospital, Herlev-Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Tine Clausen
- Department of Clinical Medicine, University of Copenhagen, Denmark
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16
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Lindkvist EB, Thorsen SU, Paulsrud C, Thingholm PR, Eriksen TLM, Gaulke A, Skipper N, Svensson J. Association of type 1 diabetes and educational achievement in 16-20-year-olds: A Danish nationwide register study. Diabet Med 2022; 39:e14673. [PMID: 34407249 DOI: 10.1111/dme.14673] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
AIMS The objective of the study was to compare grade point averages (GPAs) on compulsory school exit exams (exam GPA) and educational attainment at age 16 and 20 for individuals with and without type 1 diabetes. METHODS This study was a population-based retrospective cohort study, which included the 1991 to 1998 birth cohorts in Denmark. Follow-up was conducted at age 16 and 20 (follow-up period; 1 January, 2007 to 31 December, 2018). There were 2083 individuals with and 555,929 individuals without type 1 diabetes. Linear regression and generalized linear models compared outcomes with and without adjustments for socio-economic characteristics. RESULTS A total of 558,012 individuals (51% males) were followed to the age of 20. Having type 1 diabetes was associated with a lower exam GPA when adjusting for socio-economic status (difference: -0.05 (95% CI, -0.09 to -0.01), a higher relative risk of not completing compulsory school by age 16 (1.37, 95% CI, 1.22 to 1.53)), and a higher relative risk of not completing or being enrolled in upper secondary education by age 20 (1.05, 95% CI, 1.00 to 1.10). Haemoglobin A1c (HbA1c) <58 mmol/mol (7.5%), >7 BGM/day and insulin pump use were associated with better educational achievement. CONCLUSION Type 1 diabetes was associated with a marginally lower exam GPA and a higher risk of not completing compulsory school by age 16 and lower educational attainment by age 20. The findings were modified by HbA1c, BGM and insulin pump use.
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Affiliation(s)
- Emilie Bundgaard Lindkvist
- Department of Pediatrics and Adolescents, North Zealand Hospital, Hillerød, Denmark
- Department of Pediatrics and Adolescents, Copenhagen University Hospital, Herlev, Denmark
| | - Steffen Ullitz Thorsen
- Department of Pediatrics and Adolescents, Copenhagen University Hospital, Herlev, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie Paulsrud
- Department of Pediatrics and Adolescents, Copenhagen University Hospital, Herlev, Denmark
| | - Peter Rønø Thingholm
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | | | - Amanda Gaulke
- Department of Economics, Kansas State University, Manhattan, USA
| | - Niels Skipper
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-Based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Jannet Svensson
- Department of Pediatrics and Adolescents, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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17
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Hatun Ş, Yeşiltepe Mutlu G, Gökçe T, Avcı Ö, Yardım N, Aycan Z, Darendeliler F. Care and Support of Children with Type 1 Diabetes at School: The Turkish Experience. J Clin Res Pediatr Endocrinol 2021; 13:370-374. [PMID: 34013712 PMCID: PMC8638628 DOI: 10.4274/jcrpe.galenos.2021.2021.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Diabetes care at school has recently appeared on the agenda of international diabetes organizations, the basic principles of which have been newly determined. The aim of this review was to summarize the activities and output of the Diabetes at School Program - a program that has been delivered in Turkey for the last 10 years - and to focus on different aspects of Diabetes Care at School through a national model. Recently, a detailed set of national regulations, including the basic principles proposed by the International Society for Pediatric and Adolescent Diabetes and the experience in Turkey, was prepared and has come into force. The future agenda includes giving priority to socio-economically disadvantaged regions, provision of an Individual Treatment Plan at School for each child with diabetes and ensuring that each school has an action plan for the care of children with diabetes. We believe that if all countries have programs and structured national regulations similar to the Diabetes at School Program, this will enable significant progress in the level of care delivered to children with diabetes.
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Affiliation(s)
- Şükrü Hatun
- Koç University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey,Koç University Faculty of Medicine, Coordinator of Diabetes Program, İstanbul, Turkey
| | - Gül Yeşiltepe Mutlu
- Koç University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey,* Address for Correspondence: Koç University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey E-mail:
| | - Tuğba Gökçe
- Koç University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey
| | - Özkan Avcı
- Republic of Turkey Ministry of National Education, General Directorate of Support Services, Ankara, Turkey
| | - Nazan Yardım
- Ministry of Health of Turkey, General Directorate of Public Health, Ankara, Turkey
| | - Zehra Aycan
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Feyza Darendeliler
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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18
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Knudsen SS, Simard JF, Christensen J, Laursen TM, Deleuran BW, Bech BH. Association of Rheumatoid Arthritis in Pregnancy With School Performance of Offspring: A Danish Nationwide Register-Based Study. Arthritis Care Res (Hoboken) 2021; 73:975-982. [PMID: 32339372 DOI: 10.1002/acr.24223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the overall cognitive development of children exposed to maternal rheumatoid arthritis (RA) in utero by comparing their school test scores to those of their peers. METHODS Children born in Denmark during 1995-2008 and listed in the National School Test Register were included (n = 738,862). Children exposed to maternal RA were identified through linkage of national registers. In separate analyses, exposure was subdivided according to maternal serostatus. Preclinical maternal RA was included as a separate exposure. The Danish national school tests are mandatory standardized tests. Results from all reading tests (grades 2, 4, 6, and 8) and mathematics tests (grades 3 and 6) from 2010-2017 were included. Test scores were compared according to maternal RA exposure for each test separately using linear regressions. RESULTS We identified 934 children exposed to maternal RA in utero. There were no differences in reading test scores between maternal RA exposed and unexposed children. RA exposed children scored poorer in both mathematics tests (adjusted differences of mean score -0.14 SD (95% confidence interval [95% CI] -0.23, -0.06) and -0.16 SD (95% CI -0.26, -0.07). There was no appreciable difference between children by maternal RA serostatus. Children exposed to preclinical RA (n = 589) showed the same pattern of performance as children exposed to RA. CONCLUSION RA-exposed children scored slightly poorer in mathematics tests but performed as well as their unexposed peers in the reading tests. The results do not suggest that RA in pregnancy has a major impact on offspring school performance.
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Affiliation(s)
- Signe S Knudsen
- Aarhus University and Aarhus University Hospital, Aarhus, Denmark, and Stanford Medicine, Stanford, California
| | | | | | | | - Bent W Deleuran
- Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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19
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Eriksen TLM, Gaulke A, Skipper N, Svensson J. The impact of childhood health shocks on parental labor supply. JOURNAL OF HEALTH ECONOMICS 2021; 78:102486. [PMID: 34192649 DOI: 10.1016/j.jhealeco.2021.102486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 04/15/2021] [Accepted: 06/03/2021] [Indexed: 06/13/2023]
Abstract
We leverage the onset of type 1 diabetes (T1D) in childhood to estimate the impact of a childhood health shock on parental labor supply. T1D is the second most common childhood chronic physical health condition, inheritability is low, the exact cause is unknown, the onset is unpredictable, and receiving treatment is crucial to survival. Using Danish administrative registry data with both an event study and difference-in-differences analysis shows that mothers shift to part-time work, marginally shift from the private to public sector, and experience a long-term 4-5% decrease in wage income. The dynamic effects reveal large initial impacts, but the magnitudes decrease (although are not eliminated) over time. Fathers do not experience any long-term reduction in wage income. This suggests part of the motherhood penalty is likely due to mothers bearing the economic burden when their child is diagnosed with a chronic health condition.
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Affiliation(s)
| | - Amanda Gaulke
- Department of Economics, Kansas State University, 327 Waters Hall, 1603 Old Claflin Place, Manhattan, KS 66506, United States.
| | - Niels Skipper
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
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20
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Cyber School Is a Marker of Youth with High-Risk Diabetes. J Pediatr 2021; 230:167-173. [PMID: 33127366 PMCID: PMC7914142 DOI: 10.1016/j.jpeds.2020.10.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/13/2020] [Accepted: 10/21/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore the health characteristics of youth with diabetes in cyber school compared with peers with diabetes in traditional brick-and-mortar schools. STUDY DESIGN This was a single-center cross-sectional study of youth with type 1 or type 2 diabetes in K-12 education during academic year 2017-2018. Youth enrolled in cyber school were matched with traditional school peers by age, sex, race, diagnosis, and diabetes duration. Comparisons included insurance status, hemoglobin A1c, treatment, coexisting conditions, screening, and healthcare use. RESULTS Of 1694 participants, 5% (n = 87) were enrolled in cyber school. Youth enrolled in cyber school were predominantly white (89%), female (60%), adolescents (median 15.2 years) with type 1 diabetes (91%). Youth with type 2 diabetes were excluded from analyses owing to the small sample (n = 7). Public insurance was more common among youth enrolled in cyber school (P = .005). Youth in cyber school had higher mean hemoglobin A1c, 9.1 ± 1.8% (76 ± 20 mmol/mol) vs 8.3 ± 1.2% (67 ± 13 mmol/mol) (P = .003), lower insulin pump use (OR, 0.36; 95% CI, 0.18-0.73), and more mental health conditions (OR, 4.48; 95% CI, 1.94-10.35) compared with peers in traditional schools. Youth in cyber school were less likely to have recommended vision (OR, 0.34; 95% CI, 0.15-0.75) and dental (OR, 0.33; 95% CI, 0.15-0.75) evaluations. The relationship between hemoglobin A1c and cyber school persisted after adjusting for insurance status, pump use, and mental health conditions (P = .02). Similar trends were observed for participants with type 2 diabetes. CONCLUSIONS Youth with diabetes in cyber school may be a high-risk population. Understanding the potential impact of cyber school-related factors on health may encourage additional provider/system/school supports for these patients.
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21
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Thingholm PR, Gaulke A, Eriksen TM, Svensson J, Skipper N. Association of Prodromal Type 1 Diabetes With School Absenteeism of Danish Schoolchildren: A Population-Based Case-Control Study of 1,338 Newly Diagnosed Children. Diabetes Care 2020; 43:2886-2888. [PMID: 32900786 DOI: 10.2337/dc20-0769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/06/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate school absenteeism before the clinical diagnosis of type 1 diabetes in children who develop the disease. RESEARCH DESIGN AND METHODS This population-based, retrospective case-control study involved all Danish children who developed type 1 diabetes and attended public schools (n = 1,338) from 2010 to 2017. Those children were matched at a 1-to-5 ratio, on the basis of sex and date of birth, to children without diabetes (n = 6,690). Case and control absenteeism were compared monthly, starting with 12 months prior to the type 1 diabetes diagnosis through 12 months after diagnosis. RESULTS Before the diabetes diagnosis (7-12 months), the mean number of days absent from school per month was 0.93 (SD 1.78) among children with diabetes and 0.93 (1.82) among control children (difference -0.004 days, P = 0.94). From 4 months before the diagnosis, children who developed diabetes had a statistically significant increase in absenteeism compared with control children (difference 0.24 days, P < 0.05). CONCLUSIONS Children who were diagnosed with type 1 diabetes had increased school absenteeism 4 months before diagnosis.
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Affiliation(s)
- Peter R Thingholm
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Amanda Gaulke
- Department of Economics, Kansas State University, Manhattan, KS
| | - Tine M Eriksen
- VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | | | - Niels Skipper
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark .,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
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22
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Ghetti S, Kuppermann N, Rewers A, Myers SR, Schunk JE, Stoner MJ, Garro A, Quayle KS, Brown KM, Trainor JL, Tzimenatos L, DePiero AD, McManemy JK, Nigrovic LE, Kwok MY, Perry CS, Olsen CS, Casper TC, Glaser NS. Cognitive Function Following Diabetic Ketoacidosis in Children With New-Onset or Previously Diagnosed Type 1 Diabetes. Diabetes Care 2020; 43:2768-2775. [PMID: 32962981 PMCID: PMC7576431 DOI: 10.2337/dc20-0187] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 08/18/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study assessed whether a single diabetic ketoacidosis (DKA) episode is associated with cognitive declines in children with newly diagnosed type 1 diabetes and whether the same is true in children who had previously been diagnosed after accounting for variations in glycemic control and other relevant factors. RESEARCH DESIGN AND METHODS We prospectively enrolled 758 children, 6-18 years old, who presented with DKA in a randomized multisite clinical trial evaluating intravenous fluid protocols for DKA treatment. DKA was moderate/severe in 430 children and mild in 328 children. A total of 392 children with DKA had new onset of type 1 diabetes, and the rest were previously diagnosed. Neurocognitive assessment occurred 2-6 months after the DKA episode. A comparison group of 376 children with type 1 diabetes, but no DKA exposure, was also enrolled. RESULTS Among all patients, moderate/severe DKA was associated with lower intelligence quotient (IQ) (β = -0.12, P < 0.001), item-color recall (β = -0.08, P = 0.010), and forward digit span (β = -0.06, P = 0.04). Among newly diagnosed patients, moderate/severe DKA was associated with lower item-color recall (β = -0.08, P = 0.04). Among previously diagnosed patients, repeated DKA exposure and higher HbA1c were independently associated with lower IQ (β = -0.10 and β = -0.09, respectively, P < 0.01) and higher HbA1c was associated with lower item-color recall (β = -0.10, P = 0.007) after hypoglycemia, diabetes duration, and socioeconomic status were accounted for. CONCLUSIONS A single DKA episode is associated with subtle memory declines soon after type 1 diabetes diagnosis. Sizable IQ declines are detectable in children with known diabetes, suggesting that DKA effects may be exacerbated in children with chronic exposure to hyperglycemia.
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Affiliation(s)
- Simona Ghetti
- Department of Psychology, University of California, Davis, Davis, CA .,Center for Mind and Brain, University of California, Davis, Davis, CA
| | - Nathan Kuppermann
- Department of Emergency Medicine, UC Davis Health, UC Davis School of Medicine, Sacramento, CA.,Department of Pediatrics, UC Davis Health, UC Davis School of Medicine, Sacramento, CA
| | - Arleta Rewers
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, University of Colorado Denver, Aurora, CO
| | - Sage R Myers
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jeff E Schunk
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Michael J Stoner
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Aris Garro
- Departments of Emergency Medicine and Pediatrics, Rhode Island Hospital, The Warren Alpert Medical School, Brown University, Providence, RI
| | - Kimberly S Quayle
- Division of Emergency Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Kathleen M Brown
- Division of Emergency Medicine, Department of Pediatrics, Children's National Medical Center, The School of Medicine & Health Sciences, The George Washington University, Washington, DC
| | - Jennifer L Trainor
- Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leah Tzimenatos
- Department of Emergency Medicine, UC Davis Health, UC Davis School of Medicine, Sacramento, CA
| | - Andrew D DePiero
- Division of Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Julie K McManemy
- Division of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Lise E Nigrovic
- Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Maria Y Kwok
- Division of Emergency Medicine, Department of Pediatrics, New York Presbyterian Morgan Stanley Children's Hospital, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Clinton S Perry
- Center for Mind and Brain, University of California, Davis, Davis, CA.,Department of Psychology, Tufts University, Medford, MA
| | - Cody S Olsen
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - T Charles Casper
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
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23
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Eriksen TM, Gaulke A, Thingholm PR, Svensson J, Skipper N. Association of type 1 diabetes and school wellbeing: a population-based cohort study of 436,439 Danish schoolchildren. Diabetologia 2020; 63:2339-2348. [PMID: 32815027 DOI: 10.1007/s00125-020-05251-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/04/2020] [Indexed: 01/09/2023]
Abstract
AIMS/HYPOTHESIS We aimed to examine the association of type 1 diabetes with school wellbeing among Danish children. METHODS This is a population-based cohort study involving 436,439 Danish children, of which 1499 had a confirmed diagnosis of type 1 diabetes. The children were enrolled in grade levels 4 to 9 (middle school) in Danish public schools in the years 2014-2017. Questionnaire outcomes from the yearly National Wellbeing Survey related to self-efficacy, perceived competences, peer and teacher support, bullying and somatic symptoms were analysed. Ordered logistic regression was used to compare outcomes of children with and without type 1 diabetes, and to compare subgroups of children with type 1 diabetes by different levels of HbA1c and diabetes duration. Primary outcomes were answers to seven pre-specified questionnaire items (scale, 1 to 5). RESULTS A total of 817,679 questionnaires were initiated, of which n = 2681 were from children with type 1 diabetes. Compared with the background population, children with type 1 diabetes expressed more peer support; adjusted OR 1.17 (95% CI 1.08, 1.27). Children with diabetes also reported more often having a headache; adjusted OR 1.09 (95% CI 1.00, 1.19). Overall, children with poor glycaemic control (HbA1c >70 mmol/mol) had worse outcomes on the wellbeing measures compared with the background population. Even after adjusting for socioeconomic status, they still reported significantly worse perceived competences, less teacher support and more somatic symptoms (stomach ache and headache). CONCLUSIONS/INTERPRETATION In Denmark, children with type 1 diabetes generally feel well supported in school but have more headaches than other children. Poor glycaemic control is associated with worse psychological school-related wellbeing. Graphical abstract.
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Affiliation(s)
- Tine M Eriksen
- VIVE-The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Amanda Gaulke
- Department of Economics, Kansas State University, Manhattan, KS, USA
| | - Peter R Thingholm
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | | | - Niels Skipper
- Department of Economics and Business Economics, Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Fuglesangs Allé 4, 8210, Aarhus V., Denmark.
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24
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Begum M, Chittleborough C, Pilkington R, Mittinty M, Lynch J, Penno M, Smithers L. Educational outcomes among children with type 1 diabetes: Whole-of-population linked-data study. Pediatr Diabetes 2020; 21:1353-1361. [PMID: 32833299 DOI: 10.1111/pedi.13107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 07/08/2020] [Accepted: 08/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Challenges with type 1 diabetes (T1D) blood glucose management and illness-related school absences potentially influence children's educational outcomes. However, evidence about the impact of T1D on children's education is mixed. The objectives were to estimate the effects of T1D on children's educational outcomes, and compare time since T1D diagnosis (recent diagnosis [≤2 years] and 3 to 10 years long exposure) on educational outcomes. METHODS This whole-of-population study used de-identified, administrative linked-data from the South Australian Early Childhood Data Project. T1D was identified from hospital ICD-10-AM diagnosis codes (E10, ranging E101 to E109), from 2001 to 2014. Educational outcomes were measured in grade 5 by the National Assessment Program-Literacy and Numeracy (NAPLAN, 2008-2015) for children born from 1999 to 2005. Analyses were conducted using augmented inverse probability of treatment weighting. Multiple imputations was used to impute missing data. RESULTS Among 61 445 children born in South Australia who had undertaken NAPLAN assessments, 162 had T1D. There were negligible differences in the educational outcomes of children with and without T1D, and between recently diagnosed and those with longer exposure. For example, the mean reading score was 482.8 ± 78.9 for children with T1D and 475.5 ± 74.3 for other children. The average treatment effect of 6.8 (95% CI - 6.3-19.9) reflected one-tenth of a SD difference in the mean reading score of children with and without T1D. CONCLUSION Children with T1D performed similarly on literacy and numeracy in grade 5 (age ~ 10-years) compared to children without T1D. This could be due to effective T1D management.
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Affiliation(s)
- Mumtaz Begum
- School of Public Health, The University of Adelaide, Adelaide, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, Australia.,Department of Food and Nutrition, College of Home Economics, University of Peshawar, Peshawar, Pakistan
| | - Catherine Chittleborough
- School of Public Health, The University of Adelaide, Adelaide, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Rhiannon Pilkington
- School of Public Health, The University of Adelaide, Adelaide, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Murthy Mittinty
- School of Public Health, The University of Adelaide, Adelaide, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - John Lynch
- School of Public Health, The University of Adelaide, Adelaide, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, Australia.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Megan Penno
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia
| | - Lisa Smithers
- School of Public Health, The University of Adelaide, Adelaide, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, Australia
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25
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Nielsen NF, Gaulke A, Eriksen TM, Svensson J, Skipper N. Socioeconomic Inequality in Metabolic Control Among Children With Type 1 Diabetes: A Nationwide Longitudinal Study of 4,079 Danish Children. Diabetes Care 2019; 42:1398-1405. [PMID: 31123155 DOI: 10.2337/dc19-0184] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/29/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine inequality in glycemic control by maternal educational level among children with type 1 diabetes in a setting with universal access to health care. RESEARCH DESIGN AND METHODS This was a longitudinal nationwide study of 4,079 Danish children with type 1 diabetes between the years 2000 and 2013. Children were divided into four groups based on mothers' education prebirth (≤high school [n = 1,643], vocational or 2-year college [n = 1,548], bachelor's degree [n = 695], ≥master's degree [n = 193]). Means of socioeconomic and treatment characteristics were compared between groups. HbA1c and the number of daily glucose tests were compared repeatedly from onset until 5 years after onset across groups. HbA1c was compared across daily blood glucose testing frequency and groups. Linear regression was used to compare HbA1c across groups with and without adjustment for socioeconomic and treatment characteristics. RESULTS Large differences in HbA1c across maternal education were found. The mean level of HbA1c during follow-up was 59.7 mmol/mol (7.6%) for children of mothers with ≥master's degrees and 68.7 mmol/mol (8.4%) for children of mothers with ≤high school (difference: 9.0 mmol/mol [95% CI 7.5, 10.6]; 0.8% [95% CI 0.7, 1.0]). The associations were attenuated but remained significant after adjustment. Observable characteristics explained 41.2% of the difference in HbA1c between children of mothers with ≤high school and mothers with ≥master's degree; 22.5% of the difference was explained by more frequent blood glucose monitoring among the children with the highly educated mothers. CONCLUSIONS Family background is significantly related to outcomes for children with type 1 diabetes, even with universal access to health care.
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Affiliation(s)
- Nick F Nielsen
- Center for Economic Behavior and Inequality, Department of Economics, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Gaulke
- Department of Economics, Kansas State University, Manhattan, KS
| | - Tine M Eriksen
- VIVE - The Danish Center of Social Science Research, Copenhagen, Denmark
| | - Jannet Svensson
- Pediatrics and Adolescent Department, Copenhagen University Hospital, Herlev, Denmark
| | - Niels Skipper
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
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