1176-P: Executive Function and Quality of Life in Youth with Type 1 Diabetes

Introduction & Objective: Executive function (EF) describes cognitive processes required to plan, monitor, and execute goals - skills essential to diabetes self-management. Youth with T1D (YwT1D) are at risk for weaker EF skills. Difficulties in diabetes self-management can be associated with lower quality of life (QL). We examined the relationship between EF and QL outcomes in YwT1D.

Methods: From July 2019-September 2020, we enrolled YwT1D, diagnosed for ≥6 months, ages 10-17 years, in a study measuring EF and QL. Caregivers completed the parent-report Behavior Rating Inventory of Executive Function-2 (BRIEF) and Pediatric Quality of Life Inventory (PedsQL) Diabetes Module and Family Impact Module (FIM). Higher scores on the BRIEF indicate weaker EF skills. Higher scores on the PedsQL indicate better QL and family functioning. Demographic and clinical data was collected. In linear regression models adjusted for child’s age, sex, HbA1c, and time since T1D diagnosis, we examined associations between the BRIEF’s Global Executive Composite (GEC) scale and PedsQL scales.

Results: Baseline cohort (n=50) was 54% female, race: 56% NHW, 13% NHB, 25% Hispanic, 65% privately insured, 84% used CSII, 94% used CGM; mean age (SD) 13.8 (<u>+</u> 2.4) years, T1D duration 5.4 years (<u>+</u> 4.2), HbA1c 7.9% (<u>+</u> 1.3). One-third of youth met executive dysfunction criteria (T>65 on any BRIEF subscale). In adjusted models, each SD increase on the GEC was associated with a 6-point (95% CI -10.2, -1.9) decrease in the PedsQL Diabetes Module, an 11.2-point (95% CI -15.7, -6.6) decrease in FIM, and a 9.7% (95% CI -15.9, -3.6) decrease in CGM wear time.

Conclusion: Among YwT1D, weaker EF skills were associated with decreased diabetes-specific QL and increased impact on family functioning. Proactive surveillance and support for EF deficits in T1D self-management education may improve health-related QL and family functioning. Future research is needed to determine if integrating neuropsychology services with T1D education improves QL and glycemic outcomes.