Executive Function Predicting Longitudinal Change in Type 1 Diabetes Management During the Transition to Emerging Adulthood

Berg, Cynthia A.; Wiebe, Deborah J.; Suchy, Yana; Turner, Sara L.; Butner, Jonathan; Munion, Ascher K.; Lansing, Amy Hughes; White, Perrin C.; Murray, Mary

doi:10.2337/dc18-0351

Cited by 38 publications

(30 citation statements)

References 37 publications

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“…We based our power analysis on prior work detecting change in SR targets [4] and T1D medication adherence literature [10,11]. We anticipate medium effect sizes of 0.6 with the bundled interventions, so our proposed sample size of 94 (47 per group) should result in sufficient statistical Power of 82% to detect such effects using a two-sided Type I error alpha of 0.05.…”

Section: Powermentioning

confidence: 99%

“…SR capacity has been conceptualized as including three component processes: executive functioning skills; emotion regulation strategies; and ability to delay gratification in service of achieving future goals [3,4]. Low SR capacity has been shown to interfere with individuals' engagement in a variety of health maintenance behaviors including engaging in regular physical activity [5], consuming a healthy diet [6][7][8], and adhering to medical treatment regimens [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Adolescent Interventions to Manage Self-Regulation in Type 1 Diabetes (AIMS-T1D): randomized control trial study protocol

Miller

Albright

et al. 2020

BMC Pediatr

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Background: Self-regulation (SR), or the capacity to control one's thoughts, emotions, and behaviors in order to achieve a desired goal, shapes health outcomes through many pathways, including supporting adherence to medical treatment regimens. Type 1 Diabetes (T1D) is one specific condition that requires SR to ensure adherence to daily treatment regimens that can be arduous and effortful (e.g., monitoring blood glucose). Adolescents, in particular, have poor adherence to T1D treatment regimens, yet it is essential that they assume increased responsibility for managing their T1D as they approach young adulthood. Adolescence is also a time of rapid changes in SR capacity and thus a compelling period for intervention. Promoting SR among adolescents with T1D may thus be a novel method to improve treatment regimen adherence. The current study tests a behavioral intervention to enhance SR among adolescents with T1D. SR and T1D medical regimen adherence will be examined as primary and secondary outcomes, respectively. Methods: We will use a randomized control trial design to test the impact of a behavioral intervention on three SR targets: Executive Functioning (EF), Emotion Regulation (ER), and Future Orientation (FO); and T1D medical regimen adherence. Adolescents with T1D (n = 94) will be recruited from pediatric endocrinology clinics and randomly assigned to treatment or control group. The behavioral intervention consists of working memory training (to enhance EF), biofeedback and relaxation training (to enhance ER), and episodic future thinking training (to enhance FO) across an 8-week period. SR and treatment regimen adherence will be assessed at pre-and post-test using multiple methods (behavioral tasks, diabetes device downloads, self-and parent-report). We will use an intent-totreat framework using generalized linear mixed models to test our hypotheses that: 1) the treatment group will demonstrate greater improvements in SR than the control group, and 2) the treatment group will demonstrate better treatment regimen adherence outcomes than the control group.

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Section: Powermentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adolescent Interventions to Manage Self-Regulation in Type 1 Diabetes (AIMS-T1D): randomized control trial study protocol

Miller

Albright

et al. 2020

BMC Pediatr

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“…Other individuals may become demotivated by having higher HbA 1c values, shifting their attention away from a healthy diet and adaptive eating patterns. Executive function may also be an important variable in this respect, as lower executive function has been related to higher HbA 1c values and DEB in youth with type 1 diabetes (35,36). Hence, future research should examine this codevelopment of DEB and glycemic control, with a specific focus on reciprocal pathways and mechanisms, paying attention not only to the psychological but also the physiological level (e.g., disrupted hunger and satiety sensations due to glycemic dysregulation) (11,14).…”

Section: Discussionmentioning

confidence: 99%

Disturbed Eating Behaviors in Adolescents and Emerging Adults With Type 1 Diabetes: A One-Year Prospective Study

et al. 2019

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Disturbed eating behavior (DEB) is prevalent in youth with type 1 diabetes and is accompanied by an increased risk for complications, morbidity, and mortality. Prospective studies on DEB in the challenging transition to adulthood are scarce. This longitudinal study examined DEB over a 1-year period and investigated the directionality of effects linking DEB to diabetes-specific functioning and depressive symptoms in adolescents and emerging adults. RESEARCH DESIGN AND METHODS Three hundred youth (16-28 years old) with type 1 diabetes participated in a twowave longitudinal study. Questionnaires measured DEB (Diabetes Eating Problem Survey-Revised [DEPS-R]), self-management, diabetes distress, and depressive symptoms. HbA 1c values were obtained from physicians. Mixed ANOVA and crosslagged analysis were used to examine prospective changes and directionality of effects, respectively. RESULTS Mean DEB remained stable in the total sample, but significant individual differences were observed based on the cutoff score of the DEPS-R: 19% displayed persistent DEB and 8% increased and 7.3% decreased in DEB over time. The remaining individuals scored low on DEB over time. These four groups were differentiated based on insulin restriction, omission, diabetes-specific functioning, and depressive symptoms. Cross-lagged analyses indicated that DEB predicted relative increases in depressive symptoms over time, whereas reciprocal associations with glycemic control were found. CONCLUSIONS This longitudinal study highlights the substantial impact DEB may have in the transition to adulthood, with a substantial portion of youth with type 1 diabetes being at risk for clinical DEB. Prospective pathways linking DEB to functioning were found, emphasizing the clinical relevance of assessing DEB over time. Type 1 diabetes constitutes a risk factor for developing disturbed eating behavior (DEB), including unhealthy weight-management behaviors, such as skipping meals, binge eating, and purging, as well as more severe eating disorders (1,2). DEB constitutes a substantial concern, as up to 30% of adolescent girls with type 1 diabetes display DEB (3-5

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“…In this study no association was found between the trajectories of self-reported adherence and cognition. Emerging adults' reports of adherence did not vary greatly across the 3 years (see also Berg et al, 2018), likely making it difficult to predict the small changes that did occur. Additionally, emerging adults' self-reports of adherence are only modestly related to other metrics of adherence such as blood glucose checks (Berg et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, after teens graduated from high school and became more independent, changes in their HbA1c values were predicted by EF performance beyond IQ. Specifically, we found that (a) the teens' ability to make adaptive behavioral choices predicted, beyond IQ, changes in HbA1c from baseline to one-year follow-up (Suchy et al, 2017), and (b) the teen's performance on an EF composite comprised of both cognitive and behavioral components predicted, beyond IQ, changes in HbA1c (though, surprisingly, not changes in self-reported adherence) two years later (Berg et al, 2018).…”

mentioning

confidence: 80%

Executive Cognitive Functions and Behavioral Control Differentially Predict HbA1c in Type 1 Diabetes across Emerging Adulthood

Suchy

Butner

Wiebe

et al. 2019

J Int Neuropsychol Soc

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Objectives:To examine the contributions of two aspects of executive functioning (executive cognitive functions and behavioral control) to changes in diabetes management across emerging adulthood.Methods:Two hundred and forty-seven high school seniors with type 1 diabetes were assessed at baseline and followed up for 3 years. The baseline assessment battery included performance-based measures of executive cognitive functions, behavioral control, IQ estimate (IQ-est), and psychomotor speed; self-report of adherence to diabetes regimen; and glycated hemoglobin (HbA1c) assay kits as a reflection of glycemic control.Results:Linear and quadratic growth curve models were used to simultaneously examine baseline performance on four cognitive variables (executive cognitive functions, behavioral control, IQ, and psychomotor speed) as predictors of indices of diabetes management (HbA1c and adherence) across four time points. Additionally, general linear regressions examined relative contributions of each cognitive variable at individual time points. The results showed that higher behavioral control at baseline was related to lower (better) HbA1c levels across all four time points. In contrast, executive cognitive functions at baseline were related to HbA1c trajectories, accounting for increasingly more HbA1c variance over time with increasing transition to independence. IQ-est was not related to HbA1c levels or changes over time, but accounted instead for HbA1c variance at baseline (while teens were still living at home), above and beyond all other variables. Cognition was unrelated to adherence.Conclusions:Different aspects of cognition play a different role in diabetes management at different time points during emerging adulthood years.

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Executive Function Predicting Longitudinal Change in Type 1 Diabetes Management During the Transition to Emerging Adulthood

Cited by 38 publications

References 37 publications

Adolescent Interventions to Manage Self-Regulation in Type 1 Diabetes (AIMS-T1D): randomized control trial study protocol

Adolescent Interventions to Manage Self-Regulation in Type 1 Diabetes (AIMS-T1D): randomized control trial study protocol

Disturbed Eating Behaviors in Adolescents and Emerging Adults With Type 1 Diabetes: A One-Year Prospective Study

Executive Cognitive Functions and Behavioral Control Differentially Predict HbA1c in Type 1 Diabetes across Emerging Adulthood

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