Risk Factors for Executive Functioning Development in Preschool Children with Type 1 Diabetes

Links between Type 1 diabetes (T1D) and decreased cognitive functioning in children are well documented, but research on executive functioning (EF) in this population is more limited. Multiple T1D-related risk factors (e.g., hypoglycemia, hyperglycemia, glycemic variability, diabetic ketoacidosis) for EF have been established throughout the literature, but their individual effects have been difficult to determine given their interrelated nature. In result, cumulative risk has been proposed as a more robust predictor of EF differences in children with T1D. Moreover, despite the importance of early T1D onset as a risk factor for EF impairment, no studies have previously investigated EF in preschool-aged children, specifically. The current study addressed these gaps in the literature by, first, examining differences in EF scores between a group of preschool children aged 2-6 years old with T1D and a group without T1D. Second, individual and cumulative effects of T1D-related risk factors on EF among preschoolers with T1D were considered. A sample of 32 children (n=16 with T1D and n=15 without T1D) and their parents completed EF tasks and parent-report questionnaires; information about T1D management, including HbA1c, glycemic variability, and history of complications, was abstracted from medical records. We found that EF in preschoolers with T1D was similar to same-aged peers without T1D. Moreover, in the current sample, overall EF performance was unaffected by history of T1D complications, including DKA episodes, HbA1c, and glycemic variability. These results suggest that some young children may be protected from the effects of T1D on EF and highlight the need for early intervention and monitoring.