Objective and Subjective Influences on Cognitive Performance in Adolescents with Type 1 Diabetes
Date of Award
Master of Science (MS)
Type 1 diabetes mellitus (T1DM) is an increasingly common chronic illness in children and adolescents that can result in short- and long-term health complications. Disease management can be a particular challenge for adolescents seeking autonomy from caregivers. Recently, there has been a significant increase in adolescents’ use of diabetes-related technology to aid in blood glucose (BG) management and insulin administration. Individuals with T1DM also experience symptoms related to their BG levels, and these symptoms can serve as indicators of out-of-range BG levels and guide management decisions. Although research shows that diabetes-related health factors can affect cognitive functioning, no existing research has explored the relationship between cognitive performance and immediate symptomatology at the time of testing. The present study examined the similarities and differences between objective and subjective diabetes-related variables and their respective relationships to cognitive performance. This study also explored the use of diabetes technology in this population, and adolescents’ ability to accurately estimate their current BG levels. Fifty-five adolescents (ages 13-17) diagnosed with T1DM completed the study during a 10-day diabetes camp session. Participants completed symptom inventories and estimated their BG level before checking it with a meter. They also completed two cognitive assessments (Symbol Digit Modalities Test, or SDMT, and D-KEFS Tower Test) and a brief interview about their use of diabetes-related technologies. Adolescents whose BG levels were out of the recommended range performed more poorly on the SDMT, and those who endorsed more subjective symptomatology also took longer to make their first move on the Tower Test. Adolescents were fairly accurate in their BG estimations, most making estimates that were inaccurate but without clinically serious implications. No relationships were found between continuous glucose monitor use and BG estimation accuracy. However, participants who reported checking their BG more frequently per day with a meter made more accurate BG estimations. Overall, present findings suggest that both immediate BG levels and immediate symptomatology relate to adolescents’ cognitive function. These results underscore the importance of considering symptomatology, symptom awareness, and estimation accuracy in school settings in order to optimize adolescents’ functioning in these settings.