Motivation: A missing link in the association between executive function and self-management in youth with type 1 diabetes?

Abstract

Introduction: Self-management behavior requires executive function (EF; goal-directed behavior) skills. Behavior regulation (BR), a subcomponent of EF has been linked to diabetes self-management. Additionally, motivation may be key for changing and sustaining selfmanagement behaviors in youth with type 1 diabetes (T1D), but is understudied in pediatric diabetes. Objectives: Against the background of the Self-Determination Theory, we investigated the dynamics between motivation of youth for selfmanagement, BR and HbA1c using network analyses. Methods: Youth with T1D completed questionnaires. The SelfRegulation Questionnaire assessed motivation on three dimensions of internalization (external regulation, introjection, identification) and a rebellion scale. BR (inhibition, behavioral evaluation, emotion regulation, shift) was assessed by the Behavior Regulation Index (BRI) of Executive Function (BRIEF) composite scale. Self-management was assessed with the Diabetes Self-management Profile and by HbA1c. Network analyses in R explored partial correlations between BR, motivation and self-management, controlling for all other connections. Results: 134 youth (11-18 y/o) with T1D (mean age 14.4+2.1; 54% female; mean HbA1c 7.4%+1.0) participated. In the network analyses (Figure), BR was not directly linked to self-management; motivation was shown to be a bridging concept. More BR-shift problems related to more rebellion against self-management guidelines (r=0.2) and more BR-inhibition problems to more external regulation of motivation (r=0.24). More identification with self-management guidelines related to better self-management behavior (r = 0.24) and more rebellion to higher HbA1c (r=0.28). Conclusions: Results uncovered the importance of the clinically wellknown concept of rebellion against diabetes self-management in its associations with both BR as well as HbA1c. This emphasizes the importance for families and clinicians to focus on motivation in youth with T1