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

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.