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Original research
Type 1 diabetes mellitus and educational attainment in childhood: a systematic review
  1. Natalie Jayne Oakley1,
  2. Dylan Kneale2,
  3. Mala Mann3,
  4. Mariann Hilliar4,
  5. Colin Dayan5,
  6. John W Gregory1,
  7. Robert French5,6
  1. 1Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
  2. 2Social Science Research Unit (SSRU), University College London, London, UK
  3. 3Specialist Unit for Review Evidence, Cardiff University, Cardiff, UK
  4. 4School of Medicine Library, Cardiff University, Cardiff, UK
  5. 5Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
  6. 6Centre for Multilevel Modelling, Graduate School of Education, University of Bristol, Bristol, UK
  1. Correspondence to Dr Robert French; frenchr3{at}


Objectives The primary objective of this systematic review was to evaluate available literature on whether type 1 diabetes mellitus (T1DM) has an impact on educational attainment in individuals undertaking high stakes standardised testing at the end of compulsory schooling.

Design A systematic review was undertaken comparing educational attainment for individuals with and without T1DM who have undertaken high stakes testing at the end of compulsory schooling.

Data sources A comprehensive search of MEDLINE, MEDLINE (epub ahead of print, in-process and other non-indexed citations), EMBASE, Web of Science, British Education Index, Education Resources Information Center and Cumulative Index to Nursing and Allied Health Literature was undertaken on 15 January 2018 and updated on 17 January 2019.

Eligibility criteria Included studies fulfilled the following criteria: observational study or randomised controlled trial; included individuals who have undertaken high stakes testing at the end of compulsory schooling; compared the grades obtained by individuals with T1DM with a representative population control.

Data extraction and synthesis Two reviewers performed study selection and data extraction independently. Quality and risk of bias in the observational studies included were assessed using the Newcastle-Ottawa Scale. A detailed narrative synthesis of the included studies was completed.

Results 3103 articles were identified from the database search, with two Swedish cohort studies (using the same linked administrative data) meeting final inclusion criteria. A small but statistically significant difference was reported in mean final grades, with children with T1DM found to have lower mean grades than their non-diabetic counterparts (adjusted mean difference 0.07–0.08).

Conclusions More contemporary research is required to evaluate the impact of T1DM in childhood on educational attainment in individuals undertaking high stakes standardised testing at the end of compulsory schooling, taking into consideration the substantial advances in management of T1DM in the last decade.

PROSPERO registration number CRD42017084078.

  • diabetes to endocrinology
  • paediatric endocrinology
  • community child health

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  • Contributors RF is the review guarantor. The concept of the review was proposed by RF and JWG; the manuscript was drafted by NJO and RF, and edited by all authors. MH, NJO and RF designed the search strategy with advice from MM. NJO, MM and RF contributed to the development of the study eligibility criteria and data extraction criteria. JWG and CD provided expertise on type 1 diabetes. MM provided expertise on systematic review methodology. NJO and RF screened the titles and abstracts of records retrieved from the searches using the predetermined inclusion criteria, with any doubt or disagreement discussed with JWG. NJO and RF independently completed data extraction and assessed the quality and risk of bias of the included studies using the Newcastle-Ottawa Scale (NOS), consulting JWG if any disagreements. DK provided expertise on data extraction and analysis. All authors read, edited and approved the final manuscript.

  • Funding This research was supported in part by the MRC grant MR/N015428/1.

  • Competing interests RF has received a grant from the Medical Research Council MR/N015428/1 for his work as principal investigator of the project ‘Investigating the inter-relationship between diabetes and children’s educational achievement’.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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