Self- and parent-reported executive problems in adolescents with type 1 diabetes are associated with poor metabolic control and low physical activity.
Management of diabetes is demanding and requires efficient cognitive skills, especially in the domain of executive functioning. However, the impact of impaired executive functions on diabetes control has been studied to a limited extent. The aim of the study is to investigate the association between executive problems and diabetes control in adolescents with type 1 diabetes.



Two hundred and forty-one of 477 (51%) of 12- to 18-year-old adolescents, with a diabetes duration of >2 years in Stockholm, Uppsala, and Jönköping participated. Parents and adolescents completed questionnaires, including Behavioral Rating Inventory of Executive Function (BRIEF), Attention-Deficit/Hyperactivity Disorder (ADHD)-Rating Scale (ADHD-RS) and demographic background factors. Diabetes-related data were collected from the Swedish Childhood Diabetes Registry, SWEDIABKIDS. Self-rated and parent-rated executive problems were analyzed with regard to gender, glycosylated hemoglobin (HbA1c), frequency of outpatient visits, and physical activity, using chi-square tests or Fisher's test, where P-values <.05 were considered significant. Furthermore, adjusted logistic regressions were performed with executive problems as independent variable.



Executive problems, according to BRIEF and/or ADHD-RS were for both genders associated with mean HbA1c >70 mmol/mol (patient rating P = .000, parent rating P = .017), a large number of outpatient visits (parent rating P = .015), and low physical activity (patient rating P = .000, parent rating P = .025). Self-rated executive problems were more prevalent in girls (P = .032), while parents reported these problems to a larger extent in boys (P = .028).



Executive problems are related to poor metabolic control in adolescents with type 1 diabetes. Patients with executive problems need to be recognized by the diabetes team and the diabetes care should be organized to provide adequate support for these patients.
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.|Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
Charlotte
0000-0003-4689-0769
C
Nylander
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.|Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
Ylva
Y
Tindberg
Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden.
Josephine
J
Haas
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Ingemar
I
Swenne
Department of Women's and Children's Health, Karolinska Institute and Hospital, Stockholm, Sweden.
Torun
T
Torbjörnsdotter
Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden.|Futurum, Academy for Health and Care, Jönköping, Sweden.
Karin
K
Åkesson
Department of Women's and Children's Health, Karolinska Institute and Hospital, Stockholm, Sweden.
Eva
E
Örtqvist
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Jan
J
Gustafsson
Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Elisabeth
E
Fernell
D000293:Adolescent; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000150:complications; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000523:psychology*; D056344:Executive Function; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires

HbA1c
; adolescents; neurodevelopmental problems; type 1 diabetes mellitus