Inhibitory control and glycemic regulation in adolescents with type 1 diabetes: A cross-sectional study on the mediating role of disease duration and HbA1c

Abstract Background Type 1 diabetes (T1D) represents a significant challenge during adolescence, requiring continuous self-management that depends on well-developed executive functions. Inhibitory control, a critical component of these functions, may be associated with glycemic control and disease duration. Objective To analyze, in a population of adolescents with T1D, the association between HbA1c levels and inhibitory control, considering the potential mediating role of disease duration in this relationship. Methods Adolescents with T1D (59.6% female) were evaluated at two state referral centers. Assessments included glycemic control (glycated hemoglobin (HbA1c)), inhibitory control (Flanker task), and clinical variables. Spearman correlations, hierarchical linear regressions adjusted for age and sex, and mediation analyses with bootstrapping were conducted. Results Higher HbA1c levels were associated with longer reaction times on incongruent trials ( β = 0.360; p = 0.009), which, in turn, were associated with poorer glycemic control ( β = 0.372; p = 0.009). T1D duration was positively associated with HbA1c ( β = 0.411; p = 0.004), but not directly with inhibitory control. Poorer glycemic control was associated with lower inhibitory-control performance, partially mediated by longer diabetes duration (axb: −2.0936, 95% CI −5.4991, −0.1002). Additionally, longer disease duration was associated with lower inhibitory control, partially mediated by poor glycemic control (axb: 2.0642, 95% CI 0.5483, 4.4179). Conclusion These findings suggest that assessing inhibitory control may help identify adolescents at greater risk for poor glycemic control and in need of targeted support. This highlights the importance of developing intervention strategies that incorporate cognitive approaches within the multidisciplinary care of adolescents with T1D to improve treatment adherence and promote favorable clinical and psychosocial outcomes.