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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 and a higher risk of not completing compulsory school by age 16 and lower educational attainment by age 20. The findings were modified by HbA1c, BGM and insulin pump use. [ABSTRACT FROM AUTHOR]

Understanding causation in social-ecological systems (SES) is indispensable for promoting sustainable outcomes. However, the study of such causal relations is challenging because they are often complex and intertwined, and their analysis involves diverse disciplines. Although there is agreement that no single research approach (RA) can comprehensively explain SES phenomena, there is a lack of ability to deal with this diversity. Underlying this diversity and the challenge of dealing with it are different causal reasonings that are rarely explicit. Awareness of hidden assumptions is essential for understanding how the causal reasoning of an RA is constituted, and for promoting the integration, translation, or juxtaposition of different RAs. We identify the following elements as particularly relevant for understanding causal reasoning: methods, frameworks and theories, accounts of causation, analytical focus, and causal notions. We begin with the idea that one of these elements typically figures as an entry point to an RA. This entry point is particularly important because it generates a path dependence that orients causal reasoning. In a subsequent step, when an approach is applied, causal reasoning concretizes as a result of a particular constellation of the remaining elements. We come to these insights by studying the application of four different RAs to the same social-ecological case (the collapse of Baltic cod stocks in the 1980s). On the basis of our findings we developed a guide for the analysis of causal reasoning by raising awareness of the assumptions, key elements, and the relations between these key elements for a given RA. The guide can be used to elicit the causal reasoning of RAs, facilitate interdisciplinary collaboration, and support disclosure of ethical/political dimensions that underlie management/governance interventions that are formulated on the basis of causal findings of research studies [ABSTRACT FROM AUTHOR]