Delay discounting associated with challenges to treatment adherence and glycemic control in young adults with type 1 diabetes.

INTRODUCTION: Many young adults with type 1 diabetes (T1D) face challenges in adherence to self-management practices and have above-target HbA1c. Poorer decision-making skills, indicated by greater delay discounting, may be linked to these factors.

METHODS: An online survey using social media ads targeted young adults aged 18-26 with T1D. Participants completed the Self-Care Inventory and the 5-trial delay discounting task and self-reported their last HbA1c value.

RESULTS: Discounting was significantly associated with treatment adherence (r = -.14, p < .05) and HbA1c (r  = .18, p <  .01). Adherence was also associated with HbA1c (r = -.26, p < .01). In a hierarchical regression, adding discounting explained significant additional variance in HbA1c after controlling demographics (F(1, 257) = 3.99, p <  .05); adding adherence next explained significant additional variance in HbA1c (F(1, 256) = 12.96, p <  .01). In the final model, adherence significantly explained HbA1c variance (β = -.21, p <  .01).

DISCUSSION: These results expand the literature on cognitive factors and glycemic control among patients with T1D. Factors like delay discounting represent potentially modifiable risk factors targetable through interventions.