169-LB: Neuropsychological Consultation and Glycemic Control in Pediatric Patients

Executive function underlies the ability to plan, reason, and problem solve - skills essential to diabetes management. Children with T1D are at elevated risk of executive dysfunction. Providing families with supports to acknowledge and address these deficits may improve diabetes outcomes. In a randomized controlled trial, we evaluated whether neuropsychological consultation improved glycemic control.

From July 2019-September 2020 we enrolled patients aged 10-17 years with T1D ≥6 months. Participants were randomized at enrollment to neuropsychological consultation (n=26) or usual care (n=24). Both groups completed executive function and psychosocial assessments at baseline and follow-up plus received diabetes management education. The intervention group also underwent neuropsychological consultation followed by focused feedback. Follow-up for both groups extended for 12 months. We assessed whether neuropsychological consultation was associated with change in HbA1C from baseline to follow-up using age and sex-adjusted linear regression models in intention-to-treat and per protocol analyses.

At baseline, the mean (SD) age of participants was 13.8 (2.4) years with 51% in grades 5-8 and 49% in grades 9-12. Mean (SD) HbA1c was 7.7% (1.7); most participants used CGMs (94%) and insulin pumps (87%). Thirty-five percent of the intervention group met criteria for executive dysfunction. HbA1C was lower at follow-up in the treatment group according to both the intention-to-treat (-1.3%; 95% CI -2.5, -0.1) and per protocol (-1.3%; 95% CI -2.6, 0.1) analyses.

This small randomized controlled trial performed primarily during the COVID-19 pandemic demonstrates that neuropsychological consultation may contribute to improvement in glycemic control among pediatric patients with T1D. Next steps include examining changes in psychosocial outcomes, identifying the most impactful aspects of the consultation, and studying this intervention in a larger patient population.