School Performance of Children and Adolescents With Type 1 Diabetes: A Systematic Review

Introduction Type 1 diabetes (T1D) may negatively impact cognitive function in children and adolescents, but data regarding its impact on academic performance remains inconsistent. Aim To systematically review the evidence on academic performance assessed by school grades in youth with T1D and its association with glycemic control. Methods PubMed, Scopus, Web of Science, and Google Scholar were searched for studies evaluating academic achievement through school grades in children and adolescents with T1D and assessing its association with glycemic control. Risk of bias was evaluated using the Joanna Briggs Institute critical appraisal tool. Results Sixteen studies involving 26,794 children and adolescents with T1D met the inclusion criteria. Thirteen studies were rated as having a low risk of bias. Of 11 studies comparing school grades of children with T1D to that of peers or national norms, five reported lower performance in youth with T1D, five reported no significant differences, and one found reduced performance in primary but not secondary school. Among 10 studies examining glycemic control, eight reported that higher HbA1c levels were significantly associated with lower school grades. Conclusion Academic performance based on school grades in youth with T1D shows mixed results; however, poor glycemic control is consistently associated with reduced academic achievement. These findings underscore the importance of optimal diabetes management and highlight the need for longitudinal research to clarify causal relationships and inform interventions.