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

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.

Figure 1.

RISQ score over time stratified by executive function status assessed by (A) GEC, (B) MI, (C) BRI. (A) black circles = GEC <60, grey squares = GEC ≥60. (B) black circles = MI <60, grey squares = MI ≥60. (C) black circles = BRI <60, grey squares = BRI ≥60. Abbreviations: BRI, Behavioral Regulation Index; GEC, Global Executive Composite; MI, Metacognition Index; RISQ, Readiness for Independent Self-Care Questionnaire.