Chronic illness can affect multiple domains of functioning, yet scientific understanding of the effects across the lifespan and under multiple contexts is still developing. For instance, research consistently indicates the early years of a child's life are pivotal for early intervening to positively affect physical, cognitive, and socio-emotional development; unfortunately, the impact of chronic illnesses, and thus appropriate interventions, during this time are not well-established. Academic achievement is one area in which children with chronic illness are negatively affected and research suggests that the effects of illness can be exacerbated by certain social determinants of health and demographic characteristics; however, no recent studies have examined these relationships for children at school entry. The current study utilized the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) to examine variations in early academic readiness in reading and mathematics by diabetes status, race, and social determinants, specifically mother's education and access to early childhood education, among children born in 2001. Results of the current study indicated that children with diabetes scored lower on reading and mathematics relative to their non-diabetic peers. Significant interactions were evident for diabetes status by mother's education, race/ethnicity, and by early childhood education. Children in homes whose mothers had the lowest level of education did not score as high as children in homes with mothers who had higher levels of education. Among children without diabetes, those identified as Asian, Pacific Islander, or Native Hawaiian outperformed White, Black, Hispanic, American Indian, and multi-race groups on measures of reading and mathematics, whereas among children with diabetes, those identified as multiracial scored highest. Regardless of diabetes status, children who attended preschool outperformed those who did not, yet children without diabetes who had not attended preschool outperformed diabetic children who did receive such services. Findings support the need for targeted early intervention as preschool alone did not mitigate the effects of diabetes on academic performance.