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 HbAlc (r = -.26, p < .01). In a hierarchical regression, adding discounting explained significant additional variance in HbAlc after controlling demographics (F(1, 257) = 3.99, p < .05); adding adherence next explained significant additional variance in HbAlc (F(1, 256) = 12.96,p < .01). In the final model, adherence significantly explained HbAlc variance (beta = -.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.