Table 1.
Aspects of executive functioning in diabetes management
| Domain | Definition | Example diabetes task: bolusing insulin |
|---|---|---|
| Attentional control | • Paying attention to one thing, while ignoring other aspects of the environment | • Sustain attention long enough to complete bolus, while ignoring other environmental stimuli (e.g., TV, conversations) |
| • Focusing for a prolonged period of time | • Correctly execute steps of checking BG, calculating carbs, and giving insulin) | |
| • Monitoring actions, so that plans are executed in the correct order and errors are identified | Double check to ensure steps have been executed correctly (e.g., the correct BG number was entered into pump, or the correct I:C ratio was used) | |
| • Delaying gratification and thinking before acting | • Wait several minutes to eat after insulin has been given | |
| Cognitive flexibility | • Shifting between tasks | • A person may be engaged in conversation at the dinner table and need to stop the conversation and switch gears to diabetes care |
| • Learning from mistakes | • Take into account previous experiences (e.g., knowing to give less insulin if they know their BG goes low after exercising) | |
| • Devising alternative strategies | • Calculate insulin dose using mental math | |
| • Processing multiple sources of information concurrently (multi-tasking) | • Adapt when at a new restaurant and eating a new meal | |
| • Temporarily storing and manipulating information | ||
| Goal setting | • Planning ahead | • Plan ahead to order supplies to ensure you have a working pump, insulin, and information needed available (e.g., I:C ratio) |
| • Anticipating future events | • Anticipate when and how you will bolus (e.g., planning time to fit in a bolus in between class and lunch) | |
| • Formulating a goal | • Keep supplies organized and available when you need them (e.g., keep extra insulin at school in case something happens to current bottle) | |
| • Devising a sequence of steps to achieve a goal | ||
| • Arranging complex information in a logical, systematic, and strategic manner. |
BG blood glucose, I:C insulin to carb ratio. Domains and definitions [22]