Investigating the inter-relationship between diabetes and children's educational achievement.

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Context of researchDiabetes is one of the most common chronic childhood illnesses, affecting 1 in every 700 children. There are two types of diabetes which affect how insulin regulates blood glucose levels. In this application, we focus on Type-1 diabetes which is the most common form in childhood, arising from immune-mediated beta-cell (which produce insulin) destruction. A child with Type-1 diabetes must self-inject insulin to keep blood glucose within acceptable limits, the amount needed varying with what they have eaten and physical activity. Type 1 diabetes is estimated to account for £1 billion in direct costs and £0.9 billion in indirect costs for the UK each year. A better understanding of the processes that affect self-management during childhood will help reduce the need for costly interventions.AimsThe overall aim of the research is to better understand the interrelationship between diabetes (and diabetes management) and the educational experience. We will also explore how the relationships between diabetes and education will be affected by characteristics of the child (e.g. gender), their families (e.g. family structure) and the health services they use (e.g. characteristics of diabetes clinics). To make robust statements about these relationships a second aim must be to utilise the most advanced quantitative methods to make the most of the various datasets available.Methodological objectives1. We will identify and link individuals from different health and education datasets. This allows, for example, to make inference on the effect of glycaemic control (using measures from the National Paediatric Diabetes Audit dataset) on educational outcomes (using linked measures from the national educational database).2. We will also use 'multilevel' modelling techniques which adjust for, and allow us to make inference about the 'groupings' in which the children are nested such as families, schools and diabetes clinics. This includes using multiple measures of health and education for an individual over time.3. Where data are missing we will also use sophisticated techniques to infer what those values may be, as otherwise these individuals would simply be deleted from our analysis.Substantive objectives1. To understand how diabetes affects educational attainment. This includes how health measures like diabetes management affect achievement and also which individual characteristics modify these relationships.2. To understand how diabetes changes the health and educational trajectories of individuals, in particular changes in quality of self-management through major educational and physiological transitions.3. To quantify the effect of key groupings (these include schools, diabetes clinics and families) and their characteristics modify the relationships between health and education.Applications & benefitsThe key findings will relate to how a diagnosis of diabetes and diabetes management affects the school experience. We will disseminate these findings to clinicians through the Brecon Group network of Welsh clinics caring for children with diabetes which has developed over the last eighteen years and established the register all new cases. This will be done through a workshop held at Cardiff University for clinicians, service users, school health representatives and Diabetes Specialist Nurses. It is hoped to give practitioners a better understanding of the effects of diabetes in a context in which the young person will spend a considerable amount of their time and which will have a large impact on the quality of their self-management. We will share our findings with other researchers and policy makers through published articles in specialist journals to help develop both the methodological and substantive aspects of the understanding of the role of education and schools in the treatment of chronic childhood conditions.