Educational and Health Outcomes of Children Treated for Type 1 Diabetes: Scotland-Wide Record Linkage Study of 766,047 Children

Michael Fleming (Corresponding Author), Catherine A Fitton, Markus F C Steiner, James S McLay, David Clark, Albert King, Robert S Lindsay, Daniel F Mackay, Jill P Pell

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)


OBJECTIVE: This study was conducted to determine the association between childhood type 1 diabetes and educational and health outcomes.

RESEARCH DESIGN AND METHODS: Record linkage of nine Scotland-wide databases (diabetes register, dispensed prescriptions, maternity records, hospital admissions, death certificates, annual pupil census, school absences/exclusions, school examinations, and unemployment) produced a cohort of 766,047 singleton children born in Scotland who attended Scottish schools between 2009 and 2013. We compared the health and education outcomes of schoolchildren receiving insulin with their peers, adjusting for potential confounders.

RESULTS: The 3,330 children (0.47%) treated for type 1 diabetes were more likely to be admitted to the hospital (adjusted hazard ratio [HR] 3.97, 95% CI 3.79-4.16), die (adjusted HR 3.84, 95% CI 1.98-7.43), be absent from school (adjusted incidence rate ratio [IRR] 1.34, 95% CI 1.30-1.39), and have learning difficulties (adjusted odds ratio [OR] 1.19, 95% CI 1.03-1.38). Among children with type 1 diabetes, higher mean HbA1c (particularly HbA1c in the highest quintile) was associated with greater absenteeism (adjusted IRR 1.75, 95% CI 1.56-1.96, P < 0.001), increased school exclusion (adjusted IRR 2.82, 95% CI 1.14-6.98), poorer attainment (adjusted OR 3.52, 95% CI 1.72-7.18), and higher risk of unemployment (adjusted OR 2.01, 95% CI 1.05-3.85).

CONCLUSIONS: Children with type 1 diabetes fare worse than their peers in respect of education and health outcomes, especially if they have higher mean HbA1c. Interventions are required to minimize school absence and ensure that it does not affect educational attainment.

Original languageEnglish
Pages (from-to)1700-1707
Number of pages8
JournalDiabetes Care
Issue number9
Early online date15 Jul 2019
Publication statusPublished - Sept 2019

Bibliographical note

© 2019 by the American Diabetes Association.
Acknowledgments. This study formed part of a wider PhD thesis undertaken by M.F. within the University of Glasgow, which was published in 2017. Therefore, certain sections of this manuscript appear in the thesis, which is accessible and
downloadable from the following link:
Funding. The study was sponsored by Health Data Research UK ( (grant reference number MR/S003800/1), which is a joint investment led by the Medical Research Council, together with the National Institute for Health Research (England), the Chief Scientist Office (Scotland), Health and Care Research Wales, Health and Social Care Research and Development Division (Public Health Agency, Northern Ireland), the Engineering and Physical Sciences Research Council, the Economic and Social Research Council, the British Heart Foundation, and Wellcome (grant reference number
MR/S003800/1). The sponsor and funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication




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