Executive dysfunction is associated with poorer health-related quality of life in adolescents with type 1 diabetes: diff
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Executive dysfunction is associated with poorer health‑related quality of life in adolescents with type 1 diabetes: differences by sex Eveline R. Goethals1,2 · Lisa K. Volkening1 · Lori M. Laffel1 Accepted: 12 October 2020 © Springer Nature Switzerland AG 2020
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 65 are considered clinically elevated. For the purpose of the current study, we used a cut-off score ≥ 60 on the Global Executive Composite, the Metacognition Index, and/or the Behavioral Regulation Index as indicative of executive dysfunction.
analyses adjusting for salient factors (i.e., age, sex, diabetes duration, and HbA1c) to assess the associations of executive dysfunction (independent variable) and HRQoL (dependent variable) by both adolescent self-report and parent proxyreport. To address our research question about sex dimorphism, we included an interaction term for sex by executive dysfunction in each model. Due to the multiple comparisons, p values
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