Skip to main content

Advertisement

SpringerLink
Log in

Executive dysfunction is associated with poorer health-related quality of life in adolescents with type 1 diabetes: differences by sex

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

Type 1 diabetes (T1D) is one of the most complex and demanding chronic diseases in adolescents. Given the detrimental impact of problems with executive function (EF; the ability to initiate, plan, and monitor behavior) on health outcomes in adolescents with T1D, most studies have examined common diabetes-specific outcomes related to self-management and glycemic control. This study aims to investigate the impact of executive dysfunction on health-related quality of life (HRQoL; an individual’s perceived impact of illness and treatment on daily functioning) in adolescents with T1D from a multi-informant perspective.

Methods

In this cross-sectional study, 169 adolescents (mean ± SD age 15.9 ± 1.3 years) and their parents reported on adolescent EF and HRQoL (assessed by the BRIEF and PedsQL, respectively). Parent-youth interview and chart review provided demographic and clinical characteristics. Statistical analyses encompassed bivariate correlations, t-tests, chi-squared tests, and multivariable analyses.

Results

Adolescent self-reports and parent proxy-reports identified 13% and 32% of adolescents, respectively, as having executive dysfunction. Poorer adolescent EF was associated with poorer adolescent HRQoL by both adolescent self-report and parent proxy-report, respectively. In significant multivariable models, adjusted for adolescent age, sex, diabetes duration, and glycemic control, 21% and 24% of the variance in adolescent self-reported and parent proxy-reported HRQoL were explained by adolescent self-reported and parent proxy-reported executive dysfunction. A significant interaction of sex with adolescent self-report of executive dysfunction indicated that executive dysfunction had a greater negative impact on HRQoL in females than males (p < .01).

Conclusions

Findings suggest that the impact of EF problems in adolescents with T1D goes beyond diabetes-specific outcomes and focuses attention on the need to evaluate and preserve HRQoL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Patterson, C. C., et al. (2019). Worldwide estimates of incidence, prevalence and mortality of type 1 diabetes in children and adolescents: Results from the international diabetes federation diabetes atlas. Diabetes Research and Clinical Practice, 157, 107842.

    Article  Google Scholar 

  2. Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1 diabetes. The Lancet, 383(9911), 69–82.

    Article  Google Scholar 

  3. Wiebe, D. J., et al. (2014). Developmental processes associated with longitudinal declines in parental responsibility and adherence to type 1 diabetes management across adolescence. Journal of Pediatric Psychology, 39(5), 532–541.

    Article  Google Scholar 

  4. Hermann, J. M., et al. (2019). The Transatlantic HbA1c gap: Differences in glycaemic control across the lifespan between people included in the US T1D exchange registry and those included in the German/Austrian DPV registry. Diabetic Medicine, 37, 848–855.

    Article  Google Scholar 

  5. Oris, L., et al. (2016). Illness identity in adolescents and emerging adults with type 1 diabetes: Introducing the Illness Identity Questionnaire. Diabetes Care, 39(5), 757–763.

    Article  CAS  Google Scholar 

  6. Raymaekers, K., et al. (2017). The role of peers for diabetes management in adolescents and emerging adults with type 1 diabetes: A Longitudinal Study. Diabetes Care, 40(12), 1678–1684.

    Article  Google Scholar 

  7. Hilliard, M. E., et al. (2013). How poorer quality of life in adolescence predicts subsequent type 1 diabetes management and control. Patient Education and Counseling, 91(1), 120–125.

    Article  Google Scholar 

  8. Anderson, B. J., et al. (2017). Factors associated with diabetes-specific health-related quality of life in youth with type 1 diabetes: The Global TEENs Study. Diabetes Care, 40(8), 1002–1009.

    Article  Google Scholar 

  9. Group, W. (1995). The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization. Social Science & Medicine, 41(10), 1403–1409.

    Article  Google Scholar 

  10. Mayo, N. (2015). Dictionary of quality of life and health outcomes measurement (1st ed., p. 180). Milwaukee, WI: International Society for Quality of Life Research.

    Google Scholar 

  11. Goethals, E. R., et al. (2020). Assessing readiness for independent self-care in adolescents with type 1 diabetes: Introducing the RISQ. Diabetes Research and Clinical Practice, 162, 108110.

    Article  Google Scholar 

  12. Goethals, E. R., et al. (2018). Child and parental executive functioning in type 1 diabetes: Their unique and interactive role toward treatment adherence and glycemic control. Pediatric Diabetes, 19(3), 520–526.

    Article  Google Scholar 

  13. Vloemans, A. F., et al. (2019). Youth with type 1 diabetes taking responsibility for self-management: The importance of executive functioning in achieving glycemic control: Results from the Longitudinal DINO Study. Diabetes Care, 42(2), 225–231.

    Article  Google Scholar 

  14. Berg, C. A., et al. (2018). Executive function predicting longitudinal change in type 1 diabetes management during the transition to emerging adulthood. Diabetes Care, 41(11), 2281–2288.

    Article  Google Scholar 

  15. Ratiu, I., et al. (2018). Executive function and quality of life in individuals with Marfan syndrome. Quality of Life Research, 27(8), 2057–2065.

    Article  Google Scholar 

  16. Perez, K. M., et al. (2017). Executive function in adolescents with type 1 diabetes: Relationship to adherence, glycemic control, and psychosocial outcomes. Journal of Pediatric Psychology, 42(6), 636–646.

    PubMed  Google Scholar 

  17. Yi-Frazier, J. P., et al. (2016). Whose quality of life is it anyway? Discrepancies between youth and parent health-related quality of life ratings in type 1 and type 2 diabetes. Quality of Life Research, 25(5), 1113–1121.

    Article  Google Scholar 

  18. Kalyva, E., et al. (2011). Health-related quality of life (HRQoL) of children with type 1 diabetes mellitus (T1DM): self and parental perceptions. Pediatric Diabetes, 12(1), 34–40.

    Article  Google Scholar 

  19. Eiser, C., & Varni, J. W. (2013). Health-related quality of life and symptom reporting: Similarities and differences between children and their parents. European Journal of Pediatrics, 172(10), 1299–1304.

    Article  Google Scholar 

  20. de Wit, M., et al. (2020). Using person-reported outcomes (PROs) to motivate young people with diabetes. Current Diabetes Reports, 20(7), 23.

    Article  Google Scholar 

  21. de Wit, M., et al. (2012). Assessing diabetes-related quality of life of youth with type 1 diabetes in routine clinical care: The MIND Youth Questionnaire (MY-Q). Pediatric Diabetes, 13(8), 638–646.

    Article  Google Scholar 

  22. Hilliard, M. E., et al. (2020). Assessing health-related quality of life in children and adolescents with diabetes: Development and psychometrics of the type 1 diabetes and life (T1DAL) measures. Journal of Pediatric Psychology, 45(3), 328–339.

    Article  Google Scholar 

  23. Roth, R. M., Isquith, P. K., & Gioia, G. A. (2014). Assessment of executive functioning using the behavior rating inventory of executive function (BRIEF). In S. Goldstein & J. A. Naglieri (Eds.), Handbook of executive functioning (pp. 301–331). New York: Springer.

    Chapter  Google Scholar 

  24. Varni, J. W., Seid, M., & Kurtin, P. S. (2001). PedsQL 4.0: Reliability and validity of the pediatric quality of life inventory version 4.0 generic core scales in healthy and patient populations. Medical Care, 39(8), 800–812.

    Article  CAS  Google Scholar 

  25. Harris, P. A., et al. (2009). Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381.

    Article  Google Scholar 

  26. Anderson, L. M., et al. (2019). Patient-reported and parent proxy-reported outcomes in pediatric medical specialty clinical settings: A systematic review of implementation. Journal of Pediatric Psychology, 45, 247–265.

    Article  Google Scholar 

  27. Suchy, Y., et al. (2016). The Relation of Questionnaire and performance-based measures of executive functioning with type 1 diabetes outcomes among late adolescents. Health Psychology, 35(7), 661–669.

    Article  Google Scholar 

  28. Duke, D. C., Raymond, J. K., & Harris, M. A. (2014). The Diabetes Related Executive Functioning Scale (DREFS): Pilot results. Children’s Health Care, 43(4), 327–344.

    Article  Google Scholar 

  29. Cheng, C.-P., et al. (2016). Agreement of children and parents scores on Chinese version of pediatric quality of life inventory version 4.0: Further psychometric development. Applied Research in Quality of Life, 11(3), 891–906.

    Article  CAS  Google Scholar 

  30. Luyckx, K., Seiffge-Krenke, I., & Hampson, S. E. (2010). Glycemic control, coping, and internalizing and externalizing symptoms in adolescents with type 1 diabetes: A cross-lagged longitudinal approach. Diabetes Care, 33(7), 1424–1429.

    Article  Google Scholar 

  31. Varni, J. W., et al. (2018). PedsQL 3.2 diabetes module for children, adolescents, and young adults: Reliability and validity in type 1 diabetes. Diabetes Care, 41, 2064–2071.

    Article  Google Scholar 

  32. Lewin, A. B., et al. (2009). Validity and reliability of an adolescent and parent rating scale of type 1 diabetes adherence behaviors: The Self-Care Inventory (SCI). Journal of Pediatric Psychology, 34(9), 999–1007.

    Article  Google Scholar 

  33. Hamburger, E. R., et al. (2019). Performance-based and questionnaire measures of executive function in adolescents with type 1 diabetes. Journal of Behavioral Medicine, 42(6), 1041–1049.

    Article  Google Scholar 

  34. de Wit, M., et al. (2008). Monitoring and discussing health-related quality of life in adolescents with type 1 diabetes improve psychosocial well-being: A randomized controlled trial. Diabetes Care, 31(8), 1521–1526.

    Article  Google Scholar 

  35. Van Roy, B., et al. (2010). Understanding discrepancies in parent-child reporting of emotional and behavioural problems: Effects of relational and socio-demographic factors. BMC Psychiatry, 10, 56.

    Article  Google Scholar 

  36. Davis, E., et al. (2007). Parent-proxy and child self-reported health-related quality of life: Using qualitative methods to explain the discordance. Quality of Life Research, 16(5), 863–871.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the participating adolescents and their families.

Funding

This research was supported by NIH Grants R01DK095273, K12DK094721, and P30DK036836; JDRF Grant 2-SRA-2014-253-M-B; the Katherine Adler Astrove Youth Education Fund; the Maria Griffin Drury Pediatric Fund; and the Eleanor Chesterman Beatson Fund. Dr. Goethals’ work on this project was supported by the Belgian American Educational Foundation (BAEF) and a Mary K. Iacocca Research Fellowship provided by the Iacocca Family Foundation.

Author information

Authors and Affiliations

  1. Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA

    Eveline R. Goethals, Lisa K. Volkening & Lori M. Laffel

  2. KU Leuven, Tiensestraat 102, Leuven, Belgium

    Eveline R. Goethals

Authors
  1. Eveline R. Goethals
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lisa K. Volkening
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lori M. Laffel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ERG performed the statistical analyses and wrote the manuscript, LKV contributed to study design, data collection, statistical analyses, and review/edits of the manuscript, LML was responsible for and contributed to the study design, data collection, statistical analyses, and review/edits of the manuscript. LML is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Lori M. Laffel.

Ethics declarations

Conflict of interest

We have no relevant conflict of interest to disclose related to the current study. L.M.L. reports consultative work with Boehringer Ingelheim, Convatec, Dexcom, Insulet, Insulogic, Janssen Pharmaceuticals, Laxmi, LifeScan, Medtronic, Novo Nordisk, Roche Diagnostics, Sanofi.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent/assent was obtained from all participants in the study prior to implementation to any study procedures. Research procedures were approved by the Institutional Review Board of the Joslin Diabetes Center (Boston, MA, USA).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goethals, E.R., Volkening, L.K. & Laffel, L.M. Executive dysfunction is associated with poorer health-related quality of life in adolescents with type 1 diabetes: differences by sex. Qual Life Res 30, 751–758 (2021). https://doi.org/10.1007/s11136-020-02681-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-020-02681-5

Keywords

Search

Navigation