Department of Psychology, Drexel University, Philadelphia, Pennsylvania.
Department of Psychology, University of Nevada, Reno, Nevada.
Pediatr Diabetes. 2019 Feb;20(1):119-126. doi: 10.1111/pedi.12789. Epub 2018 Nov 13.
Adolescents with type 1 diabetes may be at elevated risk for somatic problems. This study used cross-sectional, baseline data from an intervention to examine if problems with executive function (EF) were associated with greater somatic problems independent of poor adherence and disease severity in adolescents with type 1 diabetes and above target glycemic control. In addition, it examined whether certain types of EF skills, that is, metacognitive and behavior regulation, accounted for variance in somatic problems. Ninety-three adolescents completed a glycated hemoglobin (HbA1c) blood test and parents completed adherence, somatic problems, and EF questionnaires, which measured metacognitive, behavior regulation, and global EF. Greater somatic problems had significant bivariate associations with greater global (r = 0.42, P < 0.01), metacognitive (r = 0.43, P < 0.01), and behavior regulation EF problems (r = 0.31, P < 0.01), worse adherence (r = -0.39, P < 0.01), and poorer metabolic control (r = 0.26, P < 0.05). However, when adherence, metabolic control, and EF subscales were examined together in the same model, only greater global EF problems (b = 0.15, P < 0.01) and metacognitive EF problems (b = 0.16, P < 0.01) were independently associated with greater somatic problems; behavior regulation EF problems were not independently associated with greater somatic problems when controlling for adherence. Metacognitive EF problems may predict somatic problems in adolescents with above target glycemic control above and beyond physical symptoms related to disease management, underscoring the importance of proper assessment and treatment of these distinct somatic problems.
青少年 1 型糖尿病患者可能面临更高的躯体问题风险。本研究使用干预的横断面基线数据，来检验在血糖控制达标以上的青少年 1 型糖尿病患者中，执行功能（EF）问题是否与更大的躯体问题相关，而与较差的依从性和疾病严重程度无关。此外，本研究还检验了特定类型的 EF 技能（元认知和行为调节）是否可以解释躯体问题的差异。93 名青少年完成了糖化血红蛋白（HbA1c）血液测试，父母完成了依从性、躯体问题和 EF 问卷，这些问卷测量了元认知、行为调节和整体 EF。更大的躯体问题与更大的整体 EF 问题存在显著的双变量关联（r = 0.42，P < 0.01）、元认知 EF 问题（r = 0.43，P < 0.01）和行为调节 EF 问题（r = 0.31，P < 0.01），较差的依从性（r = -0.39，P < 0.01）和较差的代谢控制（r = 0.26，P < 0.05）。然而，当在同一个模型中同时检查依从性、代谢控制和 EF 子量表时，只有更大的整体 EF 问题（b = 0.15，P < 0.01）和元认知 EF 问题（b = 0.16，P < 0.01）与更大的躯体问题独立相关；当控制依从性时，行为调节 EF 问题与更大的躯体问题不独立相关。元认知 EF 问题可能预测血糖控制达标以上的青少年的躯体问题，超过了与疾病管理相关的身体症状，这突显了对这些不同的躯体问题进行适当评估和治疗的重要性。
