Glycemic Regulation and Teacher-Reported Behaviors in Students with Type 1 Diabetes Mellitus

Youth with type 1 diabetes mellitus (T1DM) are at elevated risk for emotional and behavioral challenges. Although psychosocial screening is recommended as part of diabetes care, teacher perspectives have been largely overlooked. This study examined the associations between glycemic metrics, using continuous glucose monitoring (CGM), and teacher-reported behavior. Participants included 92 students with T1DM (mean age = 13.46 years; 46.70% female, 48.90% minority). Teachers completed the Behavior Assessment System for Children, Second Edition, Teacher Rating Scales (BASC-2 TRS). Glycemic data included mean glucose, time in range, time above/below range, glycemic variability, and hemoglobin A1c (HbA1c). Higher mean glucose, reduced time in range, and greater glycemic variability were significantly associated with more teacher-reported internalizing symptoms and school problems. Glycemic variability was also associated with more externalizing behaviors and lower adaptive functioning. Subscale and content scale analyses revealed associations between glycemic variability and behavioral challenges, such as difficulties with attention, learning, emotional regulation, and executive functioning. HbA1c was not significantly related to any behavioral outcomes. CGM metrics were more strongly associated with teacher-reported school behaviors than HbA1c. Findings highlight the value of teacher input in T1DM research to better understand how glycemic patterns relate to classroom functioning.