Telethon Kids Institute, The University of Western Australia, Perth, Australia.
Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.
Pediatr Diabetes. 2016 Mar;17(2):101-11. doi: 10.1111/pedi.12243. Epub 2014 Nov 25.
Our aim was to examine the school performance of children with type 1 diabetes in comparison to their peers, exploring changes over time, and the impact of clinical factors on school performance.
The study included data on 666 children with type 1 diabetes from the Western Australia Children's Diabetes Database. (WACDD), a population-based registry, and 3260 school and school year matched non-diabetic children. Records from the National Assessment Program - Literacy and Numeracy (NAPLAN) (2008-2011), which examines four educational outcome domains and is administered annually to all years 3, 5, 7, and 9 children in Australia, were sourced for both groups. Clinical data were obtained for the children with diabetes from the WACDD.
No significant difference was observed between those with type 1 diabetes and their peers, across any of the tested domains and school years analysed. No decline over time was observed, and no decline following diagnosis was observed. Type 1 diabetes was associated with decreased school attendance, 3% fewer days attended per year. Poorer glycaemic control [higher haemoglobin A1c (HbA1c)] was associated with a lower test score [0.2-0.3 SD per 1% (10.9 mmol/mol) increase in HbA1c], and with poorer attendance [1.8% decrease per 1% (10.9 mmol/mol) increase in HbA1c]. No association was observed with history of severe hypoglycaemia, diabetic ketoacidosis or age of onset and school test scores.
These results suggest that type 1 diabetes is not associated with a significant decrement in school performance, as assessed by NAPLAN. The association of poorer glycaemic control with poorer school performance serves as further evidence for clinicians to focus on improving glycaemic control.
本研究旨在比较 1 型糖尿病患儿与同龄人在校表现，探索其随时间的变化，并分析临床因素对在校表现的影响。
本研究纳入了来自西澳儿童糖尿病数据库（WACDD）的 666 名 1 型糖尿病患儿及 3260 名匹配的非糖尿病儿童的资料。WACDD 是一个基于人群的注册研究。所有澳大利亚 3、5、7、9 年级的儿童每年都会接受国家评估计划-读写和计算能力测试（NAPLAN），该测试评估四个教育成果领域。我们从该数据库获取了两组儿童的临床资料。
在所有测试领域和分析的学年中，1 型糖尿病患儿与同龄人之间均无显著差异。我们并未观察到随时间的下降趋势，且确诊后也无下降。与同龄人相比，1 型糖尿病患儿的年缺课天数多 3%，出勤率较低。血糖控制较差（糖化血红蛋白（HbA1c）较高）与测试成绩较低相关（HbA1c 每增加 1%（10.9mmol/mol），测试成绩降低 0.2-0.3 个标准差），且与较差的出勤率相关（HbA1c 每增加 1%（10.9mmol/mol），出勤率降低 1.8%）。严重低血糖、糖尿病酮症酸中毒或发病年龄与在校测试成绩均无关联。
NAPLAN 评估结果表明，1 型糖尿病患儿的在校表现并无显著下降。血糖控制较差与在校表现较差相关，这进一步提示临床医生应注重改善血糖控制。
