Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.
Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.
Pediatr Diabetes. 2018 May;19(3):520-526. doi: 10.1111/pedi.12552. Epub 2017 Jul 30.
Managing type 1 diabetes (T1D) requires the ability to make complex and critical decisions regarding treatment, to execute complex tasks accurately, and to make adjustments when problems arise. This requires effective neuropsychological competences of patients and their families, especially in the domain of executive functioning (EF): the ability to self-monitor, plan, solve problems, and set priorities. Previous research focused mainly on child EF, neglecting the impact of parental EF. This study included both mothers and fathers and examined associations between child and parental EF and treatment adherence to T1D in a broad age range of patients.
Parents of 270 patients (6-18 years) with T1D (mean age 12.7 years; 52.6% female) were included. Mothers (N = 232) and fathers (N = 168) completed questionnaires on child and parental EF and on treatment adherence. Analyses examined the associations linking child and parental EF to treatment adherence and glycemic control (and potential moderation effects in these associations) using hierarchical linear regression.
Child EF problems were negatively associated with treatment adherence. As an indication of moderation, this effect was stronger in older children. Better treatment adherence and glycemic control were reported when both child and parent showed less EF problems. Effects were more pronounced in mothers than in fathers.
This study demonstrated a significant interplay between child and parental EF in the association with treatment adherence and glycemic control. Researchers and clinicians should remain attentive toward the role of neuropsychological concepts such as EF. Implementation in clinical practice seems meaningful.
管理 1 型糖尿病（T1D）需要患者及其家属具备做出关于治疗的复杂和关键决策、准确执行复杂任务以及在出现问题时进行调整的能力。这需要患者及其家属具备有效的神经心理能力，尤其是在执行功能（EF）领域：自我监控、计划、解决问题和确定优先级的能力。以前的研究主要集中在儿童 EF 上，忽视了父母 EF 的影响。本研究同时纳入了母亲和父亲，并在广泛的患者年龄范围内，考察了儿童和父母 EF 与 T1D 治疗依从性之间的关联。
纳入了 270 名 T1D 患儿（6-18 岁；平均年龄 12.7 岁；52.6%为女性）的父母。母亲（N=232）和父亲（N=168）完成了关于儿童和父母 EF 以及治疗依从性的问卷。采用分层线性回归分析，考察了儿童和父母 EF 与治疗依从性和血糖控制之间的关联（以及这些关联中的潜在调节效应）。
儿童 EF 问题与治疗依从性呈负相关。作为调节作用的一个迹象，这种效应在年龄较大的儿童中更强。当儿童和父母的 EF 问题较少时，治疗依从性和血糖控制更好。母亲的影响比父亲更明显。
本研究表明，儿童和父母 EF 在与治疗依从性和血糖控制的关联中存在显著的相互作用。研究人员和临床医生应注意神经心理概念（如 EF）的作用。在临床实践中的实施似乎具有重要意义。
