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Lower Independent Self-Care Readiness Persists Over Time in Teens With Type 1 Diabetes and Executive Function

Rebecca J Vitale^1,2, Liane J Tinsley¹, Lisa K Volkening¹

¹Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, MA 02215, USA.

The Journal of Clinical Endocrinology and Metabolism

|June 12, 2024

Abstract

Purpose:

Management of type 1 diabetes is complex and benefits from adequate executive function (EF) (planning, organization, problem-solving). Teens with diabetes and executive dysfunction may have challenges with the acquisition of self-care skills.

Methods:

Over 18 months, parents of teens with type 1 diabetes aged 13 to 17 completed the Diabetes Family Responsibility Questionnaire (DFRQ) and Readiness for Independent Self-Care Questionnaire (RISQ) every 6 months. Parents assessed teen EF, completing the Behavior Rating Inventory of Executive Function (BRIEF). T-score ≥60 defined EF challenges. EF, demographic, and diabetes treatment variables predicted RISQ score over time using longitudinal mixed modeling with false discovery rate adjustment.

Results:

There were 169 teen participants (54% male) aged 15.9 ± 1.3 years, diabetes duration 8.4 ± 3.7 years, and A1c 8.6 ± 1.2%. About a third (31.4%) of teens had parent-reported BRIEF Global Executive Composite (GEC) scores ≥60. After adjusting for age, sex, and DFRQ, those with GEC <60 had a RISQ score 4.1 points higher than those with GEC ≥60, P = .016. Metacognition index (MI; adjusted for age,sex, and DFRQ) predicted RISQ while behavioral regulation index (adjusted for age, continuous glucose monitor use, DFRQ, and A1c) did not; those with MI <60 had a RISQ score 5.3 points higher than those with MI ≥60, P < .001. In all models, older teen age (P < .05) and less parental involvement (P < .001) predicted higher RISQ score.

Conclusion:

EF skills, especially metacognition, appear important for the acquisition of self-care behaviors in teens with type 1 diabetes. Evaluating EF during adolescence may identify teens needing extra support during the transition process.

Keywords:

adolescence adolescent self-management comorbidities-neuropsychiatric transition type 1 diabetes

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