MON-578 - Young Adults with Type 1 Diabetes and Executive Function Challenges Have Lower Engagement with Diabetes Technology

Introduction: Prior studies have shown that difficulties with executive function (EF) skills (such as planning, organization, and problem solving) are present in >30% of teens and young adults with type 1 diabetes (T1D). Despite similar use of diabetes technologies such as insulin pumps, continuous glucose monitors (CGM), and automated insulin delivery (AID) systems, those with T1D who have EF challenges are less likely to meet A1c targets. In this analysis of EF status in a clinic sample of adolescents and young adults with T1D, we evaluated differences in glycemic outcomes via CGM and engagement with insulin pumps/AID systems between those with and without EF challenges.

Methods: People with T1D ≥ 1 year, ages 15-35 years, completed a measure of EF (Behavior Rating Inventory of Executive Function 2 [BRIEF-2] for 15-17 year olds and BRIEF-2 Adult for 18-35 year olds) as well as demographic and diabetes-related information. EF challenges were defined as BRIEF-2 or BRIEF-2 Adult Global Executive Composite T-score ≥ 60. For those using CGM (Dexcom, Freestyle Libre, Medtronic Guardian) or insulin pumps (Omnipod, Tandem), 30 days of data were downloaded from manufacturers’ portals. T-tests, Mann-Whitney U tests, and chi-square tests compared glycemic outcomes (% time in glycemic ranges, coefficient of variation (CV), and % achieving glycemic targets) and engagement with diabetes technology (CGM and insulin pump wear time, time in automated mode, carbohydrates entered, and number of manually-initiated boluses) between those with and without EF challenges.

Results: Of 137 participants with available CGM data, 34% had EF challenges; of 120 with pump data, 31% had EF challenges. Those with EF challenges had lower time-in-range (TIR, 54% vs 62%, p=0.014), lower time-in-tight-range (32% vs 39%, p=0.021), and greater time-above-range (45% vs 36%, p=0.013) than those with EF within normal limits. There were no differences in time-below-range (1.5%, IQR 0.6-2.8% for EF within normal limits vs 1.3%, IQR 0.6-2.6% for EF challenges, p=0.501). CV was higher among those with EF challenges (0.37±0.05) than those without (0.35±0.06, p=0.046). Fewer people with EF challenges achieved >70% TIR (24% vs 42%, p=0.040) and < 36% CV (44% vs 66%, p=0.012). There were no differences in type of pump used or CGM/pump wear time by EF status. People with EF challenges had fewer manually-initiated boluses per day (4.0 vs 5.2, p=0.020) and entered fewer grams of carbohydrates per day (97 vs 127, p=0.021) than those without.

Conclusions: While AID pump use was similar among people with T1D with and without EF challenges, those with EF challenges were less likely to meet CGM-derived glycemic targets. This may be mediated by fewer manually-initiated boluses and underreporting of carbohydrate intake. Targeted interventions specific to mealtime bolus dosing may help support optimal AID system use among people with EF challenges.

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