Teens with Type 1 Diabetes and Executive Function Challenges Who Use Insulin Pumps Have Lower A1C Without Increased Risk of Diabetic Ketoacidosis or Severe Hypoglycemia

<b><i>Objective:</i></b> People with type 1 diabetes and executive function (EF) challenges (e.g., organization) often struggle with self-care. This study evaluated risks/benefits of insulin pumps in teens with EF challenges. <b><i>Research Design/Methods:</i></b> Parents of teens with type 1 diabetes completed parent-reported Behavior Rating Inventory of Executive Function. Severe hypoglycemia (SH) and diabetic ketoacidosis/hyperglycemia (DKA) events, collected prospectively, provided incidence rates (IR). A1c differences by pump use were compared by the presence/absence of EF challenges (Global Executive Composite score, EF indices). Adjusted multivariable models predicted A1c. Differences in SH and DKA IRs were evaluated by pump use and EF status, employing Poisson regressions. <b><i>Results:</i></b> In teens with EF challenges, pump-users versus nonusers had lower A1c (8.5% vs. 9.2%, <i>P</i> = 0.009). There were no A1c differences by pump use/nonuse in those without EF challenges. In multivariable analysis, A1c differences remained for those with EF challenges by one index; A1c was 0.65% lower in pump-users versus nonusers (<i>P</i> = 0.028). SH incidence did not differ by pump use or EF status. DKA incidence was lower in pump-users than nonusers (4.9 vs. 14.0 episodes/100-person-years, <i>P</i> = 0.012) and lower in teens without than with EF challenges (4.9 vs. 14.0/100-person-years, <i>P</i> = 0.012). In those without EF challenges, pump-users had lower DKA IR than nonpump-users (2.0 vs. 13.7/100-person-years, <i>P</i> = 0.003). In those with EF challenges, DKA IRs did not differ by pump use. <b><i>Conclusions:</i></b> Despite occasional prescriber hesitancy, teens with type 1 diabetes and EF challenges using insulin pumps had lower A1c without increased DKA risk compared with nonpump-users.