Date of Award

12-1-2022

Language

English

Document Type

Master's Thesis

Degree Name

Master of Arts (MA)

College/School/Department

Department of Psychology

Program

Clinical Psychology

Content Description

1 online resource (iii, 40 pages)

Dissertation/Thesis Chair

Betty Lin

Committee Members

Julia M Hormes

Keywords

executive functioning, glycemic variability, HbA1c, household income, type-1 diabetes, Diabetes in children, Diabetes in adolescence, Executive functions (Neuropsychology), Pediatric neuropsychology

Subject Categories

Psychology

Abstract

Type-1 diabetes mellitus (T1DM) has been repeatedly linked to executive functioning (EF) deficits in children and adolescents but the mechanisms underlying this association are not well understood. Chronic hyperglycemia — frequently measured as glycosylated hemoglobin A1c (HbA1c) levels — and increased glycemic variability have both been proposed as risk factors for EF difficulties in this population, but it is unclear whether they each uniquely reflect T1DM-related risk for EF deficits. Furthermore, few studies have considered interactions between glycemic factors and family-level risk factors in shaping children’s EF development. Particularly, household income may exacerbate risk associations between HbA1c or glycemic variability and EF. The current study addresses these critical issues by assessing both differential contributions and interactive effects of HbA1c, glycemic variability, and household income on EF in a sample of children and adolescents with T1DM. Children with T1DM (n = 101; M age = 12.02, SD = 2.43, range = 8-16 years) and their caregivers were recruited from a major hospital in the Northeastern U.S. Caregivers reported on child EF and household income. Children’s HbA1c and glycemic variability values were abstracted from electronic medical records. Hierarchical regression analyses were run to examine the unique and interactive contributions of HbA1c or glycemic variability and household income on EF. Results show that neither HbA1c nor glycemic variability were associated with general EF deficits. Household income was associated with difficulties in general EF and six EF subdomains (i.e., shifting, emotional control, initiating, working memory, planning/organizing, and monitoring.) There was a significant interaction between HbA1c and household income for inhibition, such that the association at low values of household income was significant but was not significant at moderate or high levels of household income. Glycemic variability was associated with poorer inhibition even when adding household income in the regression model. Preliminary findings suggest that household income is a more consistent risk factor for EF deficits than HbA1c or glycemic in children and adolescents with T1DM.

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