Executive function mediates the link between externalizing behavior and HbA1c in children and adolescents with type 1 diabetes: A cross‐national investigation

Objective Externalizing behavior (i.e., conduct problems, hyperactivity) and executive function (EF) problems in children and adolescents with type 1 diabetes (T1D) have been associated with worse diabetes‐related and psychosocial outcomes but have not been examined in relationship to each other. We...

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Bibliographic Details
Published in:Pediatric diabetes 2021-05, Vol.22 (3), p.503-510
Main Authors: Goethals, Eveline R., Lemiere, Jurgen, Snoek, Frank J., Casteels, Kristina, Luyckx, Koen, Wit, Maartje
Format: Article
Language:English
Subjects:
Adolescent
Adolescents
Behavior
Belgium
Child
Children
Cognitive ability
Cohort Studies
Diabetes
Diabetes mellitus (insulin dependent)
Diabetes Mellitus, Type 1 - blood
Diabetes Mellitus, Type 1 - psychology
Executive function
Executive Function - physiology
externalizing behavior
Female
Glucose
Glycated Hemoglobin A - metabolism
glycemic control
Hemoglobin
Humans
Hyperactivity
Impulsive behavior
Male
Metacognition
Netherlands
Problem Behavior
self‐management
Surveys and Questionnaires
Teenagers
type 1 diabetes
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Summary:Objective Externalizing behavior (i.e., conduct problems, hyperactivity) and executive function (EF) problems in children and adolescents with type 1 diabetes (T1D) have been associated with worse diabetes‐related and psychosocial outcomes but have not been examined in relationship to each other. We aimed to examine whether externalizing behavior is associated with HbA1c and whether this relationship is mediated by EF problems, specifically metacognition (i.e., ability to initiate, plan, organize and monitor behavior) and behavioral regulation (i.e., impulse control, regulation of emotion and behavior). Research design and methods Cohorts of Belgian and Dutch parents of children and adolescents (6–18 years) with T1D filled out questionnaires on externalizing behavior (Strengths and Difficulties Questionnaire; SDQ) and EF (Behavior Rating Inventory of Executive Function; BRIEF) composite scales. Treating physicians collected HbA1c values. Mediation analyses were performed separately for the BRIEF composite Metacognition and Behavior Regulation scales, correcting for age, sex and diabetes duration. Results The 335 parents of children and adolescents with T1D (mean age 12.3 ± 2.8 SD; mean HbA1c 7.6% ± 1.1 SD [60 mmol/mol ± 12.0 SD]; mean diabetes duration 5.3 ± 3.6 SD; 49.6% female) participated. Analyses showed that the association between externalizing behavior and HbA1c is mediated by metacognition (ab path Point estimate = 0.05 BCa CI 95% 0.02–0.08), and not behavioral regulation. Conclusions Results uncovered the influence externalizing behavior may have on EF problems in the metacognition domain, which in turn seem to influence HbA1c. Clinicians should be mindful of these EF problems when working with children and adolescents displaying externalizing behavior, and not only target behavioral but also cognitive processes.
ISSN:1399-543X
1399-5448
DOI:10.1111/pedi.13172