Cyber school (CS) is an online alternative to K-12 education with variable academic performance. Little is known about the health status and school achievement of youth with diabetes (DM) in CS compared to their peers. All youth with type 1 or type 2 diabetes enrolled in CS for the academic year 2017-18 were identified from a large pediatric diabetes center and matched to control subjects by diagnosis, race, sex, age and duration of DM. A retrospective chart review was conducted to identify variables such as hemoglobin a1c (HbA1c), body mass index (BMI) percentile, use of devices, adherence to recommended screenings, comorbidities, and health care utilization. Eighty youth attending CS were identified (5% of school age clinic population): 73 (91%) with type 1 DM, mean duration 6.0±4.0 years, 76 (95%) white, 48 (60%) female, mean age 14.5±3.0 years. Matching was adequate (p>0.99 all parameters). Mean HbA1c was higher in those attending CS compared to controls (9.0±1.9 vs. 8.3±1.5%, p=0.001), with no difference in BMI percentiles (72.6±27.4 vs. 76.2±22.8, p=0.4). Fewer youth in CS used insulin pumps (37% vs. 60%, p=0.01) or continuous glucose monitors, though this did not reach statistical significance (29% vs. 42%, p=0.08). Youth in CS were less likely to have recommended annual vision (58% vs. 76%, p=0.02) and dental exams (63% vs. 84%, p=0.002). Mental health diagnoses were more common among CS youth (46% vs. 20%, p<0.001) and they more often met PHQ-9 criteria for depression (42% vs. 24%, p=0.04). Youth in CS more commonly missed two or more routine diabetes appointments (31% vs. 18%, p=0.04) and had at least two emergency department visits (16% vs. 5%, p=0.02). Regarding academics, more youth in CS were documented as failing a grade or needing to make up credits (11% vs. 1%, p=0.009). In summary, CS was associated with concerning health metrics and perhaps academic outcomes. CS enrollment may reflect a high-risk population of youth with DM. Special attention from DM providers may help focus additional resources and tailor counseling to this population.


C. March: None. L.M. Leikam: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company. E. Miller: None. I. Libman: Consultant; Self; Novo Nordisk A/S.


National Institutes of Health (DK007729)

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