See Us. All of Us. Executive Function and Diabetes Identity Integration in Adolescents and Emerging Adults with Type 1 Diabetes

Managing type 1 diabetes (T1D) requires sustained cognitive and emotional work, yet little is known about how variations in executive function shape the integration of diabetes into one’s sense of self. Diabetes identity integration, the process of weaving diabetes into a livable personal identity, is essential for long-term self-management, psychosocial adjustment, and overall well-being. Using survey and clinical data from adolescents and emerging adults with T1D (ages 15-35), this study examines relationships between executive function challenges, glycemic outcomes, and diabetes identity integration within structural context. Executive function was measured using the Behavior Rating Inventory of Executive Function (BRIEF-2 for adolescents and BRIEF-2A for adults). Diabetes identity integration was assessed using the Accepting Diabetes and Personal Treatment (ADAPT) Survey. Fully adjusted linear regression models accounted for age, sex, diabetes duration, hybrid closed-loop technology use, race, and poverty status. Results indicate that executive function challenges were significantly associated with lower diabetes identity integration, independent of all covariates. Lower diabetes identity integration was also associated with higher HbA1c and lower continuous glucose monitor time in range (TIR), and these patterns were more pronounced among individuals with executive function challenges. Moreover, diabetes identity integration challenges did not occur in isolation. Executive function difficulties combined with economic disadvantage created compounded barriers to sustaining diabetes care. By examining the interplay between cognitive function, glycemic outcomes, and structural conditions, this research takes a behavioral and biocultural approach to understanding T1D self-management. These findings underscore the need for T1D care models that recognize cognitive diversity, integrate identity-based assessment, and move beyond telling patients to simply “try harder.”