Vitale Rebecca J, Tinsley Liane J, Volkening Lisa K, Laffel Lori M
Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, MA 02215, USA.
Division of Endocrinology, Department of Medicine, Brigham & Women's Hospital, Boston, MA 02115, USA.
J Clin Endocrinol Metab. 2025 Apr 22;110(5):1444-1450. doi: 10.1210/clinem/dgae391.
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.
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.
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.
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.
1型糖尿病的管理较为复杂，充分的执行功能（EF）（规划、组织、解决问题）有助于管理。患有糖尿病且存在执行功能障碍的青少年在掌握自我护理技能方面可能会面临挑战。
在18个月的时间里，13至17岁1型糖尿病青少年的父母每6个月完成一次糖尿病家庭责任问卷（DFRQ）和独立自我护理准备问卷（RISQ）。父母对青少年的执行功能进行评估，完成执行功能行为评定量表（BRIEF）。T分数≥60定义为存在执行功能挑战。使用纵向混合模型并进行错误发现率调整，执行功能、人口统计学和糖尿病治疗变量可预测随时间变化的RISQ分数。
共有169名青少年参与者（54%为男性），年龄15.9±1.3岁，糖尿病病程8.4±3.7年，糖化血红蛋白（A1c）8.6±1.2%。约三分之一（31.4%）的青少年父母报告的BRIEF总体执行复合评分（GEC）≥60。在调整年龄、性别和DFRQ后，GEC<60的青少年的RISQ分数比GEC≥60的青少年高4.1分，P = 0.016。元认知指数（MI；调整年龄、性别和DFRQ后）可预测RISQ，而行为调节指数（调整年龄、持续葡萄糖监测仪使用情况、DFRQ和A1c后）则不能；MI<60的青少年的RISQ分数比MI≥60的青少年高5.3分，P<0.001。在所有模型中，青少年年龄较大（P<0.05）和父母参与度较低（P<0.001）可预测较高的RISQ分数。
执行功能技能，尤其是元认知，对于1型糖尿病青少年掌握自我护理行为似乎很重要。在青春期评估执行功能可能会识别出在过渡过程中需要额外支持的青少年。
