Child and parental executive functioning in type 1 diabetes: Their unique and interactive role toward treatment adherence and glycemic control

Goethals, Eveline R.; Wit, Maartje de; Broeck, Nady Van; Lemiere, Jurgen; Liefferinge, Dagmar Van; Böhler, Susanne; wulf, Marian De; Dello, Elke; Laridaen, Jolien; Hecke, Lynn Van; Impe, Shana Van; Casteels, Kristina; Luyckx, Koen

doi:10.1111/pedi.12552

Cited by 27 publications

(14 citation statements)

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“…In this context, other factors affecting the relation among EF, responsibility, and glycemic control need to be considered as well. Conflicting perceptions of responsibility, family conflict, self-efficacy, adherence, parental EF, and psychological and emotional problems of youth and parents could all play a role (10,14,21,22,32).…”

Section: Discussionmentioning

confidence: 99%

“…Literature shows that parents take less responsibility when youth get older in age and pubertal status (14). Interestingly, a recent study suggests that parents' EF may compensate for EF problems of their youth to enhance treatment adherence and glycemic control (21). This might imply that for those youth with lower EF, parents may need to maintain their responsibility longer to achieve better glycemic control.…”

mentioning

confidence: 99%

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Youth With Type 1 Diabetes Taking Responsibility for Self-Management: The Importance of Executive Functioning in Achieving Glycemic Control

Vloemans

Eilander²,

Rotteveel

et al. 2018

Diabetes Care

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OBJECTIVESuccessful self-management of type 1 diabetes requires cognitive skills such as executive functioning (EF). In the transition to adolescence, youth take over responsibility for diabetes management. We set out to test: 1) the association between EF and glycemic control over time and 2) whether this association was moderated by: a) youth, shared, or parent responsibility for diabetes management and b) youth's age. RESEARCH DESIGN AND METHODSWithin the Diabetes IN DevelOpment study (DINO), parents of youth with type 1 diabetes (8-15 years at baseline; N = 174) completed a yearly assessment over 4 years. Glycemic control (HbA 1c ) was derived from hospital charts. Youth's EF was measured using the Behavior Rating Inventory of Executive Functioning (BRIEF)parent report. The Diabetes Family Responsibility Questionnaire (DFRQ)-parent report was used to assess diabetes responsibility (youth, shared, and parent). Linear generalized estimating equations were used to analyze data including youth's sex, age, and age of diabetes onset as covariates. RESULTSRelatively more EF problems are significantly associated with higher HbA 1c over time (b = 0.190; P = 0.002). More EF problems in combination with less youth responsibility (b = 0.501; P = 0.048) or more parental responsibility (b = 20.767; P = 0.006) are significantly associated with better glycemic control over time. Only age significantly moderates the relationship among EF problems, shared responsibility, and glycemic control (b = 20.024; P = 0.019). CONCLUSIONSPoorer EF is associated with worse glycemic control over time, and this association is moderated by responsibility for diabetes management tasks. This points to the importance of EF when youth take over responsibility for diabetes management in order to achieve glycemic control.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Youth With Type 1 Diabetes Taking Responsibility for Self-Management: The Importance of Executive Functioning in Achieving Glycemic Control

Vloemans

Eilander²,

Rotteveel

et al. 2018

Diabetes Care

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“…Particularly in the management of T1D, adherence to the therapeutic regimen can be adversely affected by changes in daily routine [9,10]. Moreover, glycemic control is affected by engaging in regular physical activity and psychological well-being [11].…”

Section: Introductionmentioning

confidence: 99%

Lessons learned from the continuous glucose monitoring metrics in pediatric patients with type 1 diabetes under COVID-19 lockdown

et al. 2020

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Aims Billions of people have been under lockdown in an attempt to prevent COVID-19 spread. Lifestyle changes during lockdown could lead to deterioration of glycemic control in type 1 diabetes (T1D). We aimed to assess the impact of COVID-19 lockdown on the glycemic control of pediatric patients with T1D. Methods This observational real-life study from the AWeSoMe Group assessed continuous glucose monitoring (CGM) metrics of 102 T1D patients (52.9% males, mean age 11.2 ± 3.8 years, mean diabetes duration 4.2 ± 3.8 years) who used Dexcom G5. The data were accessed without any interface between patients, caregivers, and the diabetes team. Study variables from CGM metrics were: mean glucose level, time-in-range (TIR, 70-180 mg/dL; 3.9-10 mmol/L), hypoglycemia (< 54 mg/dL; < 3 mmol/L), hyperglycemia (> 250 mg/dL; > 13.3 mmol/L), coefficient of variation (CV), and time CGM active before and during lockdown. Delta-variable = lockdown variable minus before-lockdown variable. Results The mean TIR was 60.9 ± 14.3% before lockdown, with no significant change during lockdown (delta-TIR was 0.9 ± 7.9%). TIR during lockdown was significantly correlated with TIR before lockdown (r = 0.855, P < 0.001). Patients with improved TIR (delta-TIR > 3%) were significantly older than patients with stable or worse TIR (P = 0.028). Children aged < 10 years had a significantly higher CV before lockdown and during lockdown than children aged ≥ 10 years (P = 0.02 and P = 0.005, respectively). Among children aged < 10 years, a multiple linear regression model revealed associations of age and lower socioeconomic cluster with delta-TIR (F = 4.416, P = 0.019) and with delta-mean glucose (F = 4.459, P = 0.018). Conclusions CGM metrics in pediatric patients with T1D were relatively stable during a nationwide lockdown. Intervention plans should focus on younger patients with lower socioeconomic position. Keywords Type 1 diabetes • Children and adolescents • Continuous glucose monitoring (CGM) metrics • Ambulatory glucose profile • COVID-19 lockdown Managed by Antonio Secchi.

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“…Furthermore, consistent performance of self‐care behaviors suggests that adolescents may understand long‐term health benefits, which in general is contrary to adolescents' focus on the present. Because this ability to think ahead and to set priorities is developing well into early adulthood and because adolescents differ in these capacities, it is important to examine the interplay between internalization and individual differences (eg, executive functioning). Next, although we modeled internalization and defiance as simultaneous predictors of treatment adherence, internalization and defiance are not necessarily independent, as individuals scoring low on internalization may be more prone to defiance which, in turn, could play into treatment adherence and/or glycemic control.…”

Section: Discussionmentioning

confidence: 99%

“Let's talk about it” The role of parental communication in adolescents' motivation to adhere to treatment recommendations for type 1 diabetes

et al. 2019

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Objective Grounded in Self‐Determination Theory, this study examines the role of parental expectations and communication style (ie, in an autonomy‐supportive vs controlling way) in the prediction of adolescent motivation (ie, internalization or defiance) to adhere to self‐management for type 1 diabetes. Methods Structural Equation Modeling was used in a cross‐sectional, multi‐informant study of 129 adolescents (Mage = 14.43; 54.4% girls), 110 mothers, and 98 fathers. Adolescents reported on self‐motivation, treatment adherence, and parental expectations and communication styles; parents reported on their own expectations, communication style, and perceptions of adolescent treatment adherence. Medical record review provided HbA1c values. Results Across adolescent and parent reports, parental communication of diabetes‐specific expectations and an autonomy‐supportive style of communicating expectations related positively to adolescents' internalization of diabetes self‐management and negatively to defiance against diabetes self‐management. In contrast, a controlling parental communication style showed the opposite patterns of associations. Higher adolescent defiance was related to poorer treatment adherence and worse glycemic control. Conclusions Parental communication styles related to adolescent motivation, which in turn, related to adolescent treatment adherence and glycemic control. Future longitudinal research can address the long‐term impact of both maternal and paternal communication styles on adolescent motivation to adhere to treatment and their subsequent glycemic control.

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Child and parental executive functioning in type 1 diabetes: Their unique and interactive role toward treatment adherence and glycemic control

Cited by 27 publications

References 37 publications

Youth With Type 1 Diabetes Taking Responsibility for Self-Management: The Importance of Executive Functioning in Achieving Glycemic Control

Youth With Type 1 Diabetes Taking Responsibility for Self-Management: The Importance of Executive Functioning in Achieving Glycemic Control

Lessons learned from the continuous glucose monitoring metrics in pediatric patients with type 1 diabetes under COVID-19 lockdown

“Let's talk about it” The role of parental communication in adolescents' motivation to adhere to treatment recommendations for type 1 diabetes

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