title: Decision-making in diabetes mellitus type 1.
abstract: Decreased treatment adherence in patients with diabetes mellitus type 1 (type 1 DM) may reflect impairments in decision-making and underlying associated deficits in working memory and executive functioning. Other factors, including comorbid major depression, may also interfere with decision-making. The authors sought to review the clinically relevant characteristics of decision-making in type 1 DM by surveying the literature on decision-making by patients with type 1 DM. Deficiencies in decision-making in patients with type 1 DM or their caregivers contribute to treatment nonadherence and poorer metabolic control. Animal models of type 1 DM reveal deficits in hippocampal-dependent memory tasks, which are reversible with insulin. Neurocognitive studies of patients with type 1 DM reveal lowered performance on ability to apply knowledge to solve problems in a new situation and acquired scholarly knowledge, psychomotor efficiency, cognitive flexibility, visual perception, speed of information-processing, and sustained attention. Other factors that might contribute to poor decision-making in patients with type 1 DM, include "hypoglycemia unawareness" and comorbid major depression (given its increased prevalence in type 1 DM). Future studies utilizing novel treatment strategies to help patients with type 1 DM make better decisions about their disease may improve their glycemic control and quality of life, while minimizing the impact of end-organ disease.
authors.affiliation: Dept. of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: James K
authors.initials: JK
authors.lastname: Rustad
authors.forename: Dominique L
authors.initials: DL
authors.lastname: Musselman
authors.forename: Jay S
authors.initials: JS
authors.lastname: Skyler
authors.forename: Della
authors.initials: D
authors.lastname: Matheson
authors.forename: Alan
authors.initials: A
authors.lastname: Delamater
authors.forename: Norma S
authors.initials: NS
authors.lastname: Kenyon
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cáceda
authors.forename: Charles B
authors.initials: CB
authors.lastname: Nemeroff
mesh_terms: D002648:Child; D003072:Cognition Disorders / Q000209:etiology* / Q000523:psychology; D003657:Decision Making / Q000502:physiology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male