Insulin Pump Use in Teens with Executive Function (EF) Problems and Type 1 Diabetes Is Associated with Lower A1C

Aim: Providers may avoid offering pump therapy to teens with EF challenges (planning, organization). We assessed whether the association of pump use and A1c is modified by EF status, adjusting for relevant factors. Methods: EF was assessed by parent proxy-report using Behavior Rating Inventory of Executive Function (BRIEF). T-score ≥60 defined risk of EF problems for Global Executive Composite (GEC), Behavioral Regulation Index (BRI), and Metacognition Index (MI). Parents also completed the Diabetes Family Conflict Scale (DFCS). T-tests stratified by EF status compared A1c by pump use and non-use. Generalized linear models were adjusted (Tukey) for variables with p<.1 in univariate analysis. Results: Teens (N=169, 54% male) had mean age 14.9±1.3 yrs, diagnosis age 7.5±3.6 yrs, A1c 8.5±1%, 69% pump use, 9% CGM use, and 31% with GEC ≥60. With GEC <60, A1c was similar in pump users and non-users (8.3 vs 8.6%, p=.25); with GEC ≥60, A1c was lower in pump users vs non-users (8.5 vs 9.2%, p=.009). Similar A1c patterns were seen when stratified by EF problems in BRI or MI. In multivariate analysis, with GEC <60, A1c did not differ in pump users vs non-users (8.4 vs 8.6%, p=.36), adjusting for DFCS; a similar pattern was seen with BRI <60 (p=.26) and MI <60 (p=.25). With GEC ≥60, there was a trend towards lower A1c in pump users vs non-users (8.1% vs 8.7%, p=.07), adjusting for income and CGM use. With BRI ≥60, A1c was lower in pump users vs non-users (7.8 vs 8.4%, p=.03), adjusting for CGM use and DFCS score. With MI ≥60, A1c was not significantly different in pump users vs non-users (8.0% vs 8.4%, p=.25), adjusting for income, CGM use, and DFCS score. With elevated GEC, BRI, or MI scores in above multivariate analyses, A1c was lower in CGM users vs non-users (all p<.05). Conclusion: The association of diabetes technology use with lower A1c in those with elevated BRIEF scores suggests a need to re-evaluate provider reluctance to recommend use of diabetes technologies in teens presenting with potential EF problems. Disclosure R.J.Vitale: None. L.K.Volkening: None. L.J.Tinsley: None. L.M.Laffel: Advisory Panel; Medtronic, Lilly Diabetes, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Roche Diagnostics, Provention Bio, Inc., Consultant; Dexcom, Inc., Janssen Pharmaceuticals, Inc., Medscape. Funding National Institutes of Health (P30DK036836, R01DK095273); JDRF (2-SRA-2014-253-M-B); Iacocca Family Foundation