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Executive problems in adolescents with type 1 diabetes are associated with poor metabolic control and low physical activity
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

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 only been studied to a limited extent.

Objective: To investigate the association between executive dysfunctions and diabetes control in adolescents with type 1 diabetes.

Research design and methods: 241/477 (51 %) of 12-18 year-old adolescents, with a diabetes duration of >2 years, in Stockholm. Uppsala and Jönköping participated. Parents and adolescents completed questionnaires, including BRIEF, ADHD Rating Scale (ADHD-RS) and background factors. Diabetes related data was collected from the Swedish Childhood Diabetes Registry, SWEDIABKIDS. Self-rated and parent-rated executive functioning problems were analyzed with regard to gender, HbA1c, frequency of outpatient visits and physical activity, taking background factors into account.

Results: Executive functioning problems, according to BRIEF and/or ADHD-RS, respectively, were associated with mean HbA1c > 70 mmol/mol, many outpatient visits and low physical activity for both genders. Self-rated executive problems were more prevalent in girls, while parents reported these problems to a larger extent in boys.

Conclusion: Patients with executive functioning problems need to be recognized by the diabetes team. The diabetes care should be especially tailored to provide adequate support to these patients. 

Keyword [en]
Type 1 diabetes, ADHD
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-282961OAI: oai:DiVA.org:uu-282961DiVA: diva2:917955
Available from: 2016-04-08 Created: 2016-04-08 Last updated: 2016-06-01
In thesis
1. Protective factors, health-risk behaviours and the impact of coexisting ADHD among adolescents with diabetes and other chronic conditions
Open this publication in new window or tab >>Protective factors, health-risk behaviours and the impact of coexisting ADHD among adolescents with diabetes and other chronic conditions
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Mental health problems are increasing in Swedish adolescents and mortality rates are higher in this age group than among younger. 10-20% of all adolescents suffer from a chronic medical condition (CC). Few protective factors (PF) and clustering of health-risk behaviours (HRB) are frequent among adolescents with CCs.

One of the most common CC in Swedish adolescents is type 1 diabetes mellitus (T1DM). Metabolic control often deteriorates during adolescence, especially in girls. Poor metabolic control is associated with increased risk for long-term complications, of which cognitive problems are common. However, the implication of cognitive/executive problems in patients with T1DM has not been sufficiently studied. Neither has the impact of neurodevelopmental problems (NDP), such as ADHD, on HRB in adolescents with CCs been analysed.

Methods: In paper I and II the questionnaire ”Life and Health in Youth” was distributed to all students in year nine and year two of the upper secondary school in the county of Sörmland, 2008 (n=5771) and 2011 (n=5550). Adolescents with CCs were compared to healthy peers with regard to PFs and HRBs. In paper III, the ”Five to Fifteen” questionnaire was used in 175 paediatric patients with T1DM. Patients with indications of NDPs were compared with patients without such problems with regard to metabolic control. In paper IV, the BRIEF questionnaire and the ADHD Rating Scale as well as data from the Swedish Childhood Diabetes Registry was used in 241 adolescents with T1DM. Patients with indications of executive problems were compared with patients without such problems with regard to diabetes control.

Results: CCs were associated with few PFs and clustered HRBs. The combination of CCs and low numbers of PFs was found to be associated with an increased risk of clustered HRBs. In the presence of coexisting ADHD the pattern of few PFs and clustering of HRBs was aggravated. ADHD was more common among adolescents with other CCs.

Definite memory and learning problems as well as mild executive problems were associated with poor metabolic control, especially among adolescents. Executive problems were also associated with many outpatient visits and low physical activity. Girls with T1DM tended to self-report executive problems to a larger extent than boys, while parents more often reported these problems in boys.

Conclusion: Knowledge about factors influencing treatment adherence and life in general is essential in the work with chronically ill adolescents. Focus must be put on enhancing PFs in order to avoid HRBs. Identification of coexisting NDPs, such as ADHD, is crucial, since such problems can adversely influence treatment adherence, HRBs and school achievements

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. 75 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1213
Keyword
Adolescent development, adolescent medicine, health behaviour, protective factors, risk-taking, type 1 diabetes, HbA1c, neurodevelopmental problems and ADHD
National Category
Pediatrics
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-282964 (URN)978-91-554-9553-4 (ISBN)
Public defence
2016-06-03, Rosénsalen, Ingång 95/96 nbv, Uppsala Akademiska Sjukhus, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-05-13 Created: 2016-04-08 Last updated: 2016-06-01

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