Psychiatric Disorders in Youth with T1D Can Derail Educational Attainment

Agnieszka Butwicka, PhD
Credit: Karolinska University

A study of more than 2.4 million people suggests children and adolescents with type 1 diabetes (T1D) may be more likely to underachieve educationally.

Results of the study, which was a retrospective analysis of data from national registries in Sweden, suggest people with T1D had similar likelihood of completing compulsory education, but lower odds of achieving education milestones beyond this point when compared to their counterparts without T1D. However, results pointed to significant reductions in likelihood of achieving educational milestones among those with T1D and a psychiatric disorder.¹

“In this cohort study of Swedish-born children and adolescents, we found those with T1D alone had minor differences in their educational outcomes, but those with comorbid T1D and psychiatric disorders had long-term educational underachievement compared with their healthy peers,” wrote investigators.¹

In the 21st century, few causes have been championed by public health in the same way as improving awareness and decreasing stigma surrounding psychiatric disorders. At the same time, apparent increases in the rate of T1D have become a cause for concern.² When compounded together, T1D and psychiatric disorders can have a major impact on quality of life.

At the European Association for the Study of Diabetes 2022 annual meeting, a team presented data providing an overview of the prevalence of anxiety and factors associated with increased risk for people with diabetes. A global study pooling data from multiple countries, results indicated the prevalence of anxiety among people with diabetes ranged from 39-63% among the countries included. Results of the study also suggested those with HbA1c levels greater than 7% were more likely to have moderate (13% vs. 10%; P = .03) or severe anxiety (6% vs 4%; P = .04) relative to their counterparts with an HbA1c of 7% or lower.³

The current study was led by Agnieszka Butwicka, PhD, of Karolinska Univeristy , and colleagues from institutions in Sweden with the intent of exploring whether adolescents and children with T1D have difficulties with educational outcomes and how presence of psychiatric disorders might influence these outcomes. With this in mind, investigators designed a retrospective cohort study using data from national registries in Sweden, including the Total Population Register, the Multi-Generation Register, the National Inpatient Register, the Swediabkids database, and the National Diabetes Register.¹

From the Swedish databases, investigators identified 2,454,862 individuals born in Sweden from 1973-1997 and followed up until 2013 for inclusion. Of these, 13,294 diagnosed with type 1 diabetes prior to age of 16 years for inclusion. Of those with type 1 diabetes, 7.6% (n=1012) had at least 1 psychiatric disorder. People with T1D had a median age at diagnosis of 9.5 (Interquartile range [IQR], 6.0-12.5) years.¹

The primary educational milestones of interest were completing compulsory education, being eligible to and finishing upper secondary school, and starting and finishing university. Investigators also noted compulsory school performance was assessed as part of their analyses. The exposures of interest for the study were T1D and psychiatric disorders diagnosed before the age of 16. Specific psychiatric disorders of interest in the study were neurodevelopmental disorders, depression, anxiety disorders, eating disorders, bipolar disorder, psychotic disorder, and substance misuse. Of note, the “healthy” reference cohort used in the study was characterized as people without T1D and without any psychiatric disorders.¹

Upon analysis, results indicated individuals with T1D alone had slightly lower odds of achieving the educational milestones of interest. No decreased likelihood was observed for completion of compulsory education (Odds ratio [OR], 1.09 [95% confidence interval [CI], 0.93-1.28]), but decreased likelihood was observed for eligibility for upper secondary school (OR, 0.82 [95% CI, 0.76-0.88]), ever finishing upper secondary school (OR, 0.84 [95% CI, 0.80-0.88]), ever starting college or university (OR, 0.89 [95% CI, 0.85-0.93]), and ever finishing college or university (OR, 0.86 [95% CI, 0.82-0.92]).

Decreased likelihood of achieving educational milestones was observed for those with both T1D and any psychiatric disorder, including lower odds of completion of compulsory education (OR, 0.17 [95% CI, 0.13-0.21]), eligibility for upper secondary school (OR, 0.25 [95% CI, 0.21-0.30]), ever finishing upper secondary school (OR, 0.19 [95% CI, 0.14-0.26]), ever starting college or university (OR, 0.36 [95% CI, 0.29-0.46]), and ever finishing college or university (OR, 0.30 [95% CI, 0.20-0.47).¹

“Our findings highlight the importance of identifying psychiatric disorders in pediatric patients with T1D and the need for intervention and school support to minimize the influence on academic outcomes,” investigators added.¹

References

1. Butwicka A, Liu S, Ludvigsson J. Educational Outcomes in Children and Adolescents With Type 1 Diabetes and Psychiatric Disorders. JAMA Network Open. April 2023. doi:10.1001/jamanetworkopen.2023.8135
2. Lawrence JM, Divers J, Isom S, et al. Trends in Prevalence of Type 1 and Type 2 Diabetes in Children and Adolescents in the US, 2001-2017. JAMA. 2021;326(8):717–727. doi:10.1001/jama.2021.11165
3. Iapoce C. Mental health disparities observed in people with diabetes across Europe. HCP Live. https://www.hcplive.com/view/mental-health-disparities-people-diabetes-across-europe. Published January 12, 2023. Accessed April 13, 2023.