The social and economic consequences of childhood-onset Type 1 diabetes mellitus across the lifecourse: a systematic review.
BACKGROUND
The incidence of childhood-onset (Type 1) diabetes is high, and increasing, particularly among the very young. The aim of this review was to determine the longer-term social consequences of having diabetes as a child and to determine whether adverse consequences are more severe for disadvantaged children.


METHODS
Results from published and unpublished studies were synthesized narratively to examine the impact of diabetes on education, employment and income in adulthood. The question of whether the impact differed for different social groups was also examined.


RESULTS
Case-control studies found that children with diabetes missed more school than healthy children. Most studies of attainment found no differences between children with diabetes and non-diabetic control subjects or the local population, although poor metabolic control, early-onset, longer illness duration and serious hypoglycaemic events were associated with underachievement. People with childhood-onset diabetes may experience disadvantage in employment, and have a lower income in adulthood, although diabetic complications appear to be the most important determinant of social consequences in later life.


CONCLUSIONS
Many children with diabetes--especially late-onset--perform equally well at school despite increased rates of absence, but it is not yet clear whether specific subgroups are at greater risk of educational underperformance. People with childhood-onset diabetes, however, do appear to experience some disadvantage in adult employment. Qualitative research and cohort studies are needed to fill key gaps in the existing evidence base. Future research must also examine the impact of diabetes-related risk factors on socio-economic consequences.
Milton
B
B
Division of Public Health, University of Liverpool, Liverpool, UK. bmilton@liverpool.ac.uk
Holland
P
P
Whitehead
M
M
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D016022:Case-Control Studies; D002648:Child; D017281:Cost of Illness; D003922:Diabetes Mellitus, Type 1 / Q000191:economics*; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D012959:Socioeconomic Factors