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

Eveline R Goethals; Jurgen Lemiere; Frank J Snoek; Kristina Casteels; Koen Luyckx; Maartje de Wit

doi:10.1111/pedi.13172

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

Pediatr Diabetes. 2021 May;22(3):503-510. doi: 10.1111/pedi.13172. Epub 2021 Feb 7.

Authors

Eveline R Goethals^{1

2}, Jurgen Lemiere³, Frank J Snoek⁴, Kristina Casteels³, Koen Luyckx^{1

5}, Maartje de Wit⁴

Affiliations

¹ School Psychology and Development in Context, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.
² Harvard Medical School, Joslin Diabetes Center, Boston, Massachusetts, USA.
³ Pediatrics, University Hospitals Leuven, Leuven, Belgium.
⁴ Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
⁵ Unit for Professional Training and Service in the Behavioural Sciences, University of the Free State, Bloemfontein, South Africa.

PMID: 33314616
DOI: 10.1111/pedi.13172

Abstract

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.

Keywords: adolescents; children; executive function; externalizing behavior; glycemic control; self-management; type 1 diabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Belgium
Child
Cohort Studies
Diabetes Mellitus, Type 1 / blood*
Diabetes Mellitus, Type 1 / psychology*
Executive Function / physiology*
Female
Glycated Hemoglobin / metabolism*
Humans
Male
Netherlands
Problem Behavior*
Surveys and Questionnaires

Substances

Glycated Hemoglobin A