Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
Pediatr Diabetes. 2018 Feb;19(1):98-105. doi: 10.1111/pedi.12520. Epub 2017 Mar 20.
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.
糖尿病的管理要求很高，需要高效的认知技能，尤其是在执行功能领域。然而，执行功能障碍对糖尿病控制的影响在很大程度上还没有得到研究。本研究的目的是调查 1 型糖尿病青少年执行问题与糖尿病控制之间的关系。
在斯德哥尔摩、乌普萨拉和延雪平，共有 477 名 12 至 18 岁的青少年（其中 241 名，糖尿病病程>2 年）参与了这项研究。父母和青少年完成了问卷调查，包括行为评定量表（BRIEF）、注意力缺陷多动障碍（ADHD）评定量表（ADHD-RS）和人口统计学背景因素。糖尿病相关数据从瑞典儿童糖尿病登记处（SWEDIABKIDS）收集。使用卡方检验或 Fisher 检验分析自我报告和父母报告的执行问题与性别、糖化血红蛋白（HbA1c）、门诊就诊频率和体力活动之间的关系，P 值<.05 被认为有统计学意义。此外，还进行了以执行问题为自变量的调整后逻辑回归分析。
BRIEF 和/或 ADHD-RS 显示，执行问题与男女青少年的平均 HbA1c>70mmol/mol（患者评分 P=0.000，家长评分 P=0.017）、就诊次数多（家长评分 P=0.015）和体力活动少（患者评分 P=0.000，家长评分 P=0.025）有关。自我报告的执行问题在女孩中更为常见（P=0.032），而父母报告的这些问题在男孩中更为严重（P=0.028）。
执行问题与 1 型糖尿病青少年代谢控制不良有关。糖尿病团队需要识别出有执行问题的患者，并组织糖尿病护理，为这些患者提供充分的支持。
