Good glycaemic control improves school grades in type one diabetes

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Adapted from Medscape article by Peter Russell 6 Dec 2022

Children with type one diabetes have more school absences than classmates who do not have the condition, but difficulties with blood sugar control were linked to the most absences.

Despite lower attendances many children with type one diabetes achieve good exam grades and go on to higher education. But those with higher HbA1c levels were more likely to get poorer grades and found it harder to get a place at college level.

Cardiff researchers think that children who struggle with their glycaemic control could benefit from more clinical and educational support.

Researchers looked at over a quarter of a million children aged 6 to 18 and over a thousand children with type one diabetes who attended schools and colleges in Wales between 2009 and 2016. Factors such as the child’s household socioeconomic status, neighbourhood deprivation, sex and age were taken into account.

The results showed that type one children were absent for 8.8 sessions per year more than children without diabetes. Those with the best glycaemic control missed 6.7 sessions per year and children with the poorest levels of control missed 14.8 sessions.

Children in the quintile with the best glycaemic control got results 4 grades higher than those without diabetes at the age of 16. However for those in the lowest quintile of HbA1c control attainment was 5 grades lower than their classmates who did not have the condition.

Those with the best glycaemic management were 1.7 times more likely to gain a place in higher education than the general population whereas those in the lowest quintile for glycaemic management were 0.4 times as likely to go onto higher education than those who did not have type one diabetes. In essense those in the highest quintile were almost three times more likely to attend higher education than in the least optimal quintile.

Dr Robert French, one of the researchers was impressed that children with diabetes under adequate control were as likely to progress to higher education as their non diabetic peers even though they lost more school days to diabetes.

Overachievement for children with type one diabetes who effectively managed their glycaemic control could be due to factors unrelated to glucose levels and could reflect socioeconomic conditions, family support and effective self management.

Robert French et al. Educational attainment and childhood onset type one diabetes. Diabetes Care 1 Dec 2022 45(12) 2852-2851.

My comment: I know from my own experience of being a parent of a child with type one diabetes that the formulation of strictly kept routines around blood sugar testing, meals, homework, activity, and sleep made a big difference to my son’s blood sugar control and educational attainment. By my son’s diagnosis it had been already discovered that 9 out of 10 diabetic children had worse school attainment than average for their peers and that high blood sugars affected concentration, mood and memory. It would seem that for most diabetic children the educational gap has been greatly improved in the 20 years since. The overachievement affect is understandable when a child or young adult is given more family support, and this is usually maternal support, during their adolescent years, than is perhaps the case for non diabetic children. The adoption of a low carb diet makes glycaemic control much easier for all diabetics and this is even more important when the hormonal surges of puberty are causing glycaemic uproar, and the need to perform in exams can determine future career paths.