Research conducted with youth with type 1 diabetes (T1D) has shown that glycemic extremes and poorer T1D management are associated with poorer performance on measures of executive functioning (EF) compared to non-T1D counterparts. Deficits in EF may negatively impact the development of healthy T1D management skills. Our primary aim was to conduct a meta-analytic review of previous studies investigating the associations between glycemic control and EF in children with T1D across the developmental span. Comprehensive literature searches were conducted using PubMed, MedLine, PsycInfo, Google Scholar, and EBSCO for articles that met eligibility criteria. Eligibility criteria included correlational, randomized, and non-randomized studies published after 1985 involving participants ages 0-26 with a diagnosis of T1D. Studies evaluated EF using the Behavior Rating Inventory of Executive Functioning (BRIEF) or fMRI and evaluated glycemic control using Hemoglobin A1c. Across twelve studies examining the effect of glycemic control on EF in patients with T1D, 2,204 children, adolescents, and emerging adults were included in the study. Effect sizes (Hedges' g) were calculated between the T1D group and either control participants or a normative sample. Participant age was included as a moderator to determine whether the hypothesized association varied in magnitude across development. Participant A1c was used as a moderator to determine whether the hypothesized variation varied with diabetic management. A trend towards poorer performance on measures of executive functioning was observed in the T1D group compared to the normative sample (g = -0.22). In comparing age cohorts to the normative sample, a significantly poorer performance on measures of EF was observed in the 9-11, 15-17, and 18-26 age cohorts (g = -0.201, -0.258, and -0.452, respectively) compared to other age cohorts. Overall, research indicates that poor diabetic management may result in poorer performance on measures of EF compared to non-diabetic participants. These findings imply that this trend of poorer EF in children and adolescents with type 1 diabetes may lead to suboptimal diabetic management. Research suggests that suboptimal diabetic management often persists across the lifespan. Examining this association across critical periods where diabetes management may exert the most influence on the developing brain may provide guidance about when youth may benefit most from T1D management interventions.
College and Department
Family, Home, and Social Sciences; Psychology
BYU ScholarsArchive Citation
McDaniel, Hannah Margot, "Associations Between Glycemic Control and Executive Functioning in Type 1 Diabetes: A Systematic Review and Meta-Analysis" (2022). Theses and Dissertations. 9632.
type 1 diabetes, glycemic control, HbA1c, executive functioning, diabetic management, attention, inhibition, working memory, cognitive flexibility, development