medwireNews: Assessing executive function and screening for disordered eating behaviors could help identify teenagers with type 1 diabetes who will benefit from interventions aimed at improving long-term outcomes, researchers report in Diabetic Medicine.
“Executive function problems and disordered eating behaviours are two major challenges that can emerge during adolescence and potentially negatively impact self-care behaviours and glycaemia,” explain Lori Laffel (Joslin Diabetes Center, Boston, Massachusetts, USA) and co-authors.
They now report finding “important associations” between the two measures in a group of 169 teenagers (median age 16.0 years, 46% girls) with type 1 diabetes for a median of 8.9 years.
According to the Diabetes Eating Problem Survey Revised, 59% of participants were classified as having low levels of disordered eating behaviors, while 29% had moderate levels, and 12% high levels.
There was a significant difference in the levels of disordered eating by sex, with low, moderate, and high levels found in 51%, 29%, and 21% of girls, respectively, versus 65%, 29%, and 5% of boys, the investigators observe.
The teenagers were asked to complete the self-report version of the Behavior Rating Inventory of Executive Function while their parents completed the proxy-report version. These included the Global Executive Composite (GEC), comprising the clinical scales of the Behavioral Regulation Index (BRI) and the Metacognition Index (MI).
Overall, a GEC score of 60 or higher, indicating executive function problems, was self-reported by 9% of teenagers and by 26% of parents on the proxy-report. The corresponding self-reported and parent proxy-reported rates of behavioral regulation problems (BRI ≥60) were 8% and 18%, while the rates of problems related to organization and working memory (MI ≥60) were 10% and 27%.
Laffel et al report that teenagers with moderate or high levels of disordered eating behaviors were significantly more likely than individuals with low levels to have a GEC score of at least 60 reported by themselves (18 and 19 vs 2%) or by a parent (31 and 38 vs 20%). Higher levels of disordered eating were also associated with BRI score but only the parent proxy-report found a correlation between disordered eating level and MI score.
The researchers believe that executive function problems may “cause difficulties” for teenagers with type 1 diabetes who must manage diet, activity, glucose and insulin levels, and symptoms, potentially resulting “in glucose levels outside of the target range that could be compounded by disordered eating behaviours, especially those associated with insulin restriction or omission.”
They suggest that “[i]f clinicians are aware of potential difficulties with executive function, they can also be alert for disordered eating behaviours and intervene at the first sign before such behaviours become established and more difficult to treat.”
Laffel et al therefore conclude: “In teens with type 1 diabetes and disordered eating behaviours, a focus on executive function—and any specific domains that are impaired—may be a new target in the management of disordered eating behaviours to prevent progression to clinical eating disorders.”
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