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

研究背景糖尿病是最常见的儿童慢性疾病之一，每700名儿童中就有1人患有糖尿病。有两种糖尿病会影响胰岛素调节血糖水平的方式。在这个应用程序中，我们关注的是1型糖尿病，这是儿童中最常见的形式，由免疫介导的β细胞（产生胰岛素）破坏引起。患有1型糖尿病的儿童必须自我注射胰岛素以将血糖保持在可接受的范围内，所需的量随他们的饮食和身体活动而变化。据估计，英国每年1型糖尿病的直接成本为10亿英镑，间接成本为9亿英镑。更好地了解影响儿童自我管理的过程将有助于减少对昂贵干预措施的需求。目的本研究的总体目的是更好地了解糖尿病（和糖尿病管理）与教育经验之间的相互关系。我们还将探讨糖尿病与教育之间的关系将如何受到儿童特征（例如性别），家庭（例如家庭结构）和他们使用的卫生服务（例如糖尿病诊所的特征）的影响。为了对这些关系做出可靠的陈述，第二个目标必须是利用最先进的定量方法来充分利用各种可用的数据集。方法论的objectives1。我们将识别并连接来自不同健康和教育数据集的个人。例如，这允许推断血糖控制（使用来自国家儿科糖尿病审计数据集的测量）对教育成果的影响（使用来自国家教育数据库的关联测量）。我们还将使用“多层”建模技术来调整，并允许我们对儿童嵌套的“分组”做出推断，例如家庭，学校和糖尿病诊所。这包括使用个人长期健康和教育的多种措施。如果数据缺失，我们也将使用复杂的技术来推断这些值可能是什么，否则这些个体将从我们的分析中删除。实质性的objectives1。了解糖尿病如何影响受教育程度。这包括糖尿病管理等健康措施如何影响成就，以及哪些个人特征改变了这些关系。2 .了解糖尿病如何改变个人的健康和教育轨迹，特别是通过主要的教育和生理转变改变自我管理质量。量化关键群体（包括学校、糖尿病诊所和家庭）的影响及其特征改变了健康与教育之间的关系。主要研究结果将涉及糖尿病诊断和糖尿病管理如何影响学校体验。我们将通过布雷肯集团威尔士诊所网络向临床医生传播这些发现，这些诊所在过去的18年里发展了糖尿病儿童，并建立了所有新病例的登记册。这将通过在卡迪夫大学为临床医生、服务使用者、学校保健代表和糖尿病专科护士举办的讲习班来完成。这是希望给从业者一个更好的理解糖尿病的影响的背景下，年轻人将花费相当多的时间，这将对他们的自我管理的质量产生很大的影响。我们将通过在专业期刊上发表文章，与其他研究人员和政策制定者分享我们的发现，以帮助发展对教育和学校在儿童慢性疾病治疗中的作用的方法论和实质性理解。

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.