Type 1 diabetes in fair to good control not associated with reduced school performance in children

Reference

Skipper N, Gaulke A, Sildorf SM, Eriksen TM, Nielsen NF, Svensson J. Association of type 1 diabetes with standardized test scores of Danish schoolchildren. JAMA 2019;321(5):484-492.

Synopsis

Adverse outcomes of diabetes—including hypoglycemia, ketoacidosis, and hyperglycemia—may affect cognitive performance. These investigators obtained data from multiple registries in Denmark, including school test scores, age at onset and duration of diabetes, disease identification and outcomes, HbA1c level, episodes of hypoglycemia or ketoacidosis, treatment (insulin dose and pen or pump use), and socioeconomic status and other family demographics. The study cohort was 631,620 Danish children in public schools, of which 2031 had diabetes. The mean age of the study population was 10.31 years and the mean duration of diabetes was 4.5 years. The primary outcome was pooled test scores in reading and math comparing children with and without diabetes, including a case-sibling analysis. Among children with diabetes, 18.3% presented initially with diabetic ketoacidosis and 64.0% used insulin pumps. No statistically significant difference in pooled reading and math test scores were seen between children with and without diabetes after correcting for potential confounders including age, grade, and socioeconomic status. Similarly, no significant differences in test scores were seen between children with diabetes and their siblings without diabetes. A history of diabetic ketoacidosis, age at onset of diabetes, onset younger than 6 years, having experienced at least 1 episode of severe hypoglycemia, and diabetes duration longer than 4 years were also not associated with significantly lower test scores. However, having a mean HbA1c value of greater than 8.6% over the previous 3 annual measurements was associated with significantly lower test scores.