Adolescents with type 1 diabetes (T1D) with a comorbid psychiatric disorder are associated with worse educational outcomes compared to their peers, according to research published in JAMA Network.
During childhood, T1D is among the most common inherited chronic disease. Younger patients with T1D are also at an increased risk of psychiatric disorders, such as depression, anxiety, and neurodevelopmental disorders. Several studies have found that those with T1D have an increased propensity for school absenteeism and lower examination scores, which can lead to adult unemployment. Researchers aimed to examine the educational outcomes of those with T1D with psychiatric disorders and those without. Patients were assessed on whether a comorbidity is associated with an increased risk of adverse educational outcomes.
A total of 2,454,862 adolescents aged a median of 9.5 years, were included in the study, with 13,294 diagnosed with T1D. The researchers used the Swediabkids database and the National Diabetes Register to identify patients with T1D, and the Clinical Database for Child and Adolescent Mental Health Services and Habilitation Register in Stockholm County was used to obtain psychiatric disorder diagnoses. Included psychiatric disorders consisted primarily of neurodevelopmental disorders (autism, ADHD, learning disorders, communication disorders, depression, anxiety, eating disorders, bipolar disorder, psychotic disorder and substance abuse).
The primary endpoint was to examine educational outcomes of those with T1D with and without psychiatric disorders. Secondary endpoints consisted of associations amongst different types of psychiatric disorders on educational outcomes. Educational milestones that were evaluated consisted of achievement of compulsory school performance and being eligible for upper secondary school, as well as starting and finishing university.
Multivariate adjustment models found that adolescents with T1D and no psychiatric disorders were comparable to those without T1D and no psychiatric disorders in achieving educational milestones (OR, 1.09; 95% CI, 0.93-1.28). Of the adolescents included, 7.6% had a diagnosis of at least 1 psychiatric disorder before the age of 16 and a higher likelihood of having asthma, epilepsy, or autoimmune disorders. The researchers noted adolescents diagnosed with T1D and psychiatric disorders had lower odds of achieving educational milestones, including completing their required education (odds ratio [OR], 0.17; 95% CI, 0.13-0.21), being eligible for secondary school (OR, 0.25; 95% CI, 0.21-0.30), and finishing upper secondary school (OR, 0.19; 95% CI, 0.14-0.26). Additionally, diagnosed adolescents had difficulty starting (OR, 0.36; 95% CI, 0.29-0.46) or finishing (OR, 0.30; 95% CI, 0.20-0.47) a university.
Of all psychiatric disorders, those with neurodevelopmental disorders were the most disadvantaged. Adolescents with T1D and a psychiatric disorder had a lower odd of completing compulsory school (OR, 0.09; 95% CI, 0.06-0.13), being eligible for secondary school (OR, 0.19; 95% CI, 0.14-0.25) and finishing (OR, 0.26; 95% CI, 0.20-0.34) upper secondary school, and starting university (OR, 0.26; 95% CI, 0.14-0.47). Overall, adolescents with T1D may benefit from identifying psychiatric disorders early to lower the effect on educational performance.
Study limitations include the inability to capture up to date changes in pediatric treatment of diabetes, as well as screen for all psychiatric disorders, and the possible educational gap when compared to other countries.
The researchers concluded “in support of the current diabetes guidelines, clinical vigilance of psychiatric disorders in pediatric patients with diabetes is warranted.” They added, “Early detection and timely intervention can minimize the adverse effects of psychiatric disorders not only on diabetes outcomes but also on educational attainment, which can further influence other life course outcomes.”
Liu S, Ludvigsson JF, Lichtenstein P, et al. Educational outcomes in children and adolescents with type 1 diabetes and psychiatric disorders. JAMA Netw Open. 2023;6(4):e238135. doi:10.1001/jamanetworkopen.2023.8135