Award Title: The association between glycaemic control in young people with Type 1 diabetes mellitus and executive functioning in social contexts: a pilot study
Funder: The Academy of Medical Sciences

Abstract: Type I diabetes mellitus (T1DM) is associated with impairments in multiple cognitive domains including executive functions (working memory, inhibition, cognitive flexibility and decision-making). It is unknown whether these deficits are amplified in social contexts as a result of dysglycaemia affecting both executive functioning and social cognitive skills. Understanding the interplay between these cognitive skills is important for evaluating real-life behaviours and developing interventions to combat the emergence of T1DM-related complications in adolescence and adulthood. This pilot study aims to address this knowledge gap by investigating the association between quality of glycaemic control and executive functioning in neutral and social contexts in adolescents with T1DM.

There are three main objectives. Firstly, I will investigate whether glycaemic control indicators (HbA1c, glucose variability, proportion of time with hyperglycaemia) are associated with decrements in executive functioning in 12-16-year-olds with T1DM. Secondly, I will analyse whether these dysglycaemia-related decrements in executive functioning are exacerbated in social compared to neutral contexts. Thirdly, this study will generate pilot data to inform further studies examining T1DM and adolescent neurocognitive development. 

Participants will be recruited from a hospital-based paediatric diabetes service, whose service users have been involved in study design. Cognitive data will be collected remotely using a secure online testing platform, and glucose data will be collected using continuous glucose monitoring sensors and from hospital records. 

This study will allow better understanding of the impact of long-term and current glycaemic control on adolescent cognitive development, and inform future studies and interventions aimed at improvingT1DM management for young people.

Lay Abstract: Managing type 1 diabetes during adolescence can be particularly challenging, and sugar control is often poor, increasing the likelihood of long-term diabetes-related health complications. Poor diabetes control in adolescence is thought to result from disease pathology and suboptimal management as individuals begin assuming responsibility for their diabetes while simultaneously experiencing many biological, psychological and social changes. Understanding adolescent cognitive development may help when developing strategies to facilitate engagement from young people in their own diabetes management by providing insight into their motivations and behaviours.
This project will investigate whether quality of sugar control in 12-16 year-olds with diabetes is associated with skills in decision-making, stopping automatic responses, shifting between tasks and manipulating information. These skills, termed ‘executive functions’, together control our behaviours and will be measured using four computer-based tasks via an online secure platform. Each task assesses executive function with neutral objects e.g. shapes and with faces, which require participants to process social information during the task. Diabetes is predicted to impact on both executive functions and social information processing skills. Adolescents with poor sugar control, assessed using continuous glucose monitoring sensors and clinical records, are expected to perform less well on executive functions tests than their peers with better sugar control, and it is expected that these differences will be exacerbated when the tasks also contain social information.
Evaluating how adolescents with diabetes process information in social contexts is crucial for understanding real-life behaviours and developing interventions to enhance diabetes management and reduce incidence of long-term complications.

Research Activity Codes: 7.1 INDIVIDUAL CARE NEEDS;2.1 BIOLOGICAL AND ENDOGENOUS FACTORS
Health Categories: METABOLIC AND ENDOCRINE