P-435: Experiences with diabetes technology among adolescents and emerging adults with type 1 diabetes and executive function challenges: a qualitative study
O Cain, A I Patterson, H Ruggles, D A DeWalt, R J VitaleAbstract
Introduction
Type 1 diabetes (T1D) requires complex, multi-step self-management. Executive function (EF) challenges, impacting organization, planning, and problem-solving, are common among adolescents and emerging adults with T1D and may impact diabetes technology use and outcomes.
Objectives
To explore how adolescents/emerging adults with T1D and EF challenges perceive and use diabetes technologies, and how EF influences self-management and access to care.
Methods
Participants ages 15-34 years with T1D who screened positive for EF challenges in another study (Behavior Rating Inventory of Executive Function-2 [BRIEF-2] or BRIEF-2 Adult Global Executive Composite or Behavioral, Cognitive, or Emotional Regulation Indices ≥ 60) shared their experiences with diabetes management and diabetes technology use in semi-structured interviews. Interviews were transcribed and analyzed using directed qualitative content analysis. A multidisciplinary team developed a coding framework and identified themes through iterative consensus.
Results
31 participants (mean age 24.5 years, 36% male) identified 4 interconnected themes: (1) high cognitive, mental, and emotional burden of diabetes associated with a strong sense of personal responsibility; (2) technology as a double-edged sword, highlighting both improved glycemic outcomes and increased burden from devices; (3) importance of social support (family, peers, clinicians) in facilitating technology use; and (4) structural and systemic barriers, reflecting challenges with healthcare systems, access, and daily life integration.
Conclusions
Adolescents/emerging adults with T1D and EF challenges experience significant cognitive, social, and systemic barriers to effective diabetes technology use. The themes illustrate how EF challenges shape both engagement with diabetes technologies and the ability to sustain their use. Interventions that address executive function demands and enhance support systems could lead to more equitable and sustained use of diabetes technologies.