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Aims:The objective of the study was to compare grade point averages (GPAs) on compulsory school exit exams (exam GPA) and educational attainment at age 16 and 20 for individuals with and without type 1 diabetes.Methods: This study was a population-based retrospective cohort study, which included the 1991 to 1998 birth cohorts in Denmark. Follow-up was conducted at age 16 and 20 (follow-up period; 1 January, 2007 to 31 December, 2018). There were 2083 individuals with and 555,929 individuals without type 1 diabetes.Linear regression and generalized linear models compared outcomes with and without adjustments for socio-economic characteristics.Results: A total of 558,012 individuals (51% males) were followed to the age of 20. Having type 1 diabetes was associated with a lower exam GPA when adjusting for socio-economic status (difference: −0.05 (95% CI, −0.09 to −0.01), a higher relative risk of not completing compulsory school by age 16 (1.37, 95% CI, 1.22 to 1.53)), and a higher relative risk of not completing or being enrolled in upper secondary education by age 20 (1.05, 95% CI, 1.00 to 1.10). Haemoglobin A1c (HbA1c) <58 mmol/mol (7.5%), >7 BGM/day and insulin pump use were associated with better educational achievement. Conclusion:Type 1 diabetes was associated with a marginally lower exam GPA

Aims/hypothesis We aimed to examine the association of type 1 diabetes with school wellbeing among Danish children. Methods This is a population-based cohort study involving 436,439 Danish children, of which 1499 had a confirmed diagnosis of type 1 diabetes. The children were enrolled in grade levels 4 to 9 (middle school) in Danish public schools in the years 2014-2017. Questionnaire outcomes from the yearly National Wellbeing Survey related to self-efficacy, perceived competences, peer and teacher support, bullying and somatic symptoms were analysed. Ordered logistic regression was used to compare outcomes of children with and without type 1 diabetes, and to compare subgroups of children with type 1 diabetes by different levels of HbA 1c and diabetes duration. Primary outcomes were answers to seven pre-specified questionnaire items (scale, 1 to 5). Results A total of 817,679 questionnaires were initiated, of which n = 2681 were from children with type 1 diabetes. Compared with the background population, children with type 1 diabetes expressed more peer support; adjusted OR 1.17 (95% CI 1.08, 1.27). Children with diabetes also reported more often having a headache; adjusted OR 1.09 (95% CI 1.00, 1.19). Overall, children with poor glycaemic control (HbA 1c >70 mmol/mol) had worse outcomes on the wellbeing measures compared with the background population. Even after adjusting for socioeconomic status, they still reported significantly worse perceived competences, less teacher support and more somatic symptoms (stomach ache and headache). Conclusions/interpretation In Denmark, children with type 1 diabetes generally feel well supported in school but have more headaches than other children. Poor glycaemic control is associated with worse psychological school-related wellbeing.

A host of different factors affect health and longevity, ranging from genetic endowments to public policy. Physicians have a substantial influence on patients' health and health-related costs, but we know little about the extent of this influence beyond clinical decisions such as adequate diagnosis and treatment. This paper demonstrates that the health management styles of primary care physicians significantly affect the health outcomes of their patients. Using data on the population of statin users in Denmark and matching patients to their primary care physicians, we show that the physician's ability to facilitate adherence with prescription medications has significant positive effects on patient outcomes and health costs even after controlling for observable and unobservable patient characteristics. Policy interventions aimed at improving this aspect of physicians' health management styles have important implications for patient outcomes and health care costs.

Objective Mean differences in HbA1c across centers are well established, but less well understood. The aim was to assess whether differences in patient case‐mix can explain the variation in mean HbA1c between pediatric diabetes centers in Denmark. The association between HbA1c, frequency of blood glucose monitoring (BGM), treatment modality, and center visits was investigated. Research Design and Methods This longitudinal nationwide study included 3866 Danish children with type 1 diabetes from 2013 to 2017 (n = 12,708 child‐year observations) from 16 different pediatric diabetes centers. Mean HbA1c, proportion of children reaching HbA1c treatment target (HbA1c ≤ 58 mmol/mol [7.5%]) were compared across centers using linear regression models. This was done with and without adjustment for socioeconomic characteristics (patient case‐mix). Results The mean difference in HbA1c during follow‐up was 11.6 mmol/mol (95% CI 7.9, 15.3) (1.1% [95% CI 0.7, 1.4]) when comparing the centers with the lowest versus highest mean HbA1c. The difference was attenuated and remained significant after adjustment for the patient case‐mix (difference: 10.5 mmol/mol [95% CI 6.8, 14.2] (1.0% [95% CI 0.6, 1.3])). Overall, 6.8% of the differences in mean HbA1c across centers were explained by differences in the patient case‐mix. Across centers, more frequent BGM was associated with lower HbA1c. The proportion of insulin pump users and number of visits was not associated with HbA1c. Conclusion In a setting of universal health care, large differences in HbA1c across centers were found, and could not be explained by patient background, number of visits or use of technology. Only BGM was associated with center HbA1c.