Executive Function Predicts T1D Management Into Emerging Adulthood

checking blood sugar
checking blood sugar
Individuals with higher executive function performance at baseline experienced slower increases in HbA1c.

According to a study published in Diabetes Care, higher executive function is predictive of better glycemic control in teenagers with type 1 diabetes during the “high-risk” transition period between late adolescence and early emerging adulthood.

During this 2-year longitudinal study, researchers sought to determine whether glycemic control and adherence with type 1 diabetes treatment worsen as teenagers advance into adulthood, and whether the teens’ level of executive function predicts these changes. A total of 220 high school seniors (mean age, 17.77 years) with type 1 diabetes were assessed at baseline for general intelligence (IQ) and performance-based measures of executive function. Additionally, each individual self-reported problems with executive function and treatment adherence. Hemoglobin A1c (HbA1c) was measured at baseline and throughout the study period using mail-in kits.

Using conditional and unconditional growth models to examine linear change, researchers found that HbA1c level increased significantly (0.507%/year) and adherence with treatment declined across all time points. Furthermore, higher IQ was associated with lower HbA1c level at baseline, and individuals with higher executive function performance at baseline experienced slower increases in HbA1c level. There was, however, significant variability among participants at baseline and in changes in adherence across time.

Of note, participants’ self-reported issues with executive function were associated with worse glycemic control and poorer adherence at baseline, but these issues did not predict changes in HbA1c or adherence over time.

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The researchers highlighted several limitations to their study, including an inability to generalize findings to the broader population because all of the participants’ parents were of a similar socioeconomic status.

Despite such limitations, the researchers said their results support the notion that emerging adulthood is a high-risk time for diabetes management, adding, “early emerging adults (especially those with low [executive function] abilities) may benefit from multiple supports… in order to facilitate their adherence behaviors and maintain good glycemic control during this transitional time.”


Berg CA, Wiebe DJ, Suchy Y, et al. Executive function predicting longitudinal change in type 1 diabetes management during the transition to emerging adulthood [published online August 21, 2018]. Diabetes Care. doi:10.2337/dc18-0351