Fatigue in women with type 2 diabetes

Prevalence and correlates of insomnia and fatigue in patients with type 2 diabetes in Jordan

Objective: The present study examined the prevalence and correlates of insomnia and fatigue in patients with type-2 diabetes in Jordan.Methods: This was a cross-sectional online study involving a convenience sample of 390 patients with type-2 diabetes. Insomnia was assessed by the Insomnia-Severity Index (ISI-A) and fatigue by the Brief Fatigue Inventory (BFI-A).Results: Severe insomnia was present in 132 patients (33.8%), and was correlated with length of diabetes (diagnosis >5 years) (OR = 2.13, 95% CI = 1.19-3.81, P = 0.01), presence of uncontrolled diabetes (OR = 1.97, 95% CI = 1.45-2.69, P < 0.001), taking gabapentin (OR = 2.07, 95% CI = 1.07-4.01, P = 0.003), and age (<40 years) (OR = 0.30, 95% CI = 0.13-0.69, P = 0.005). Significant fatigue was also prevalent and correlated with gender (female) (B = 9.25, t = 4.48, P < 0.001), age (<40 years) (B = 7.56, t = 2.56, P = 0.01), a diagnosis of hypertension (B = 4.74, t = 2.03, P = 0.04), uncontrolled diabetes (B = 7.21, t = 4.82, P < 0.001), and taking a sulfonylurea (B = 8.03, t = 3.37, P < 0.001), carbamazepine (B = 10.93, t = 2.65, P = 0.008), or gabapentin (B = 12.60, t = 3.83, P < 0.001).Conclusion: Given the high prevalence of insomnia and fatigue in this population, increased attention by primary healthcare providers to these symptoms in diabetic patients is required, particularly in developing countries such as Jordan.

Factors Associated With Fatigue in Persons With Atrial Fibrillation in the Atherosclerosis Risk in Communities (ARIC) Study

BACKGROUND

Atrial fibrillation (AF) is a common cardiac arrhythmia affecting over 6 million people in the U.S. Fatigue is a frequent symptom of AF, yet no underlying biological mechanisms have been identified in AF-related fatigue as in other chronic conditions such as cancer or HIV fatigue (inflammation, tissue injury). We aimed to identify biomarkers and correlates of AF-fatigue in ARIC participants.

METHODS

Participants with AF from ARIC visit 5 (2011-2013) were included in the study. Multiple linear regression was used to estimate the association of high sensitivity troponin (hs-TnT), N-terminal fragment B-type natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hsCRP) levels with self-reported fatigue (SF-12 and PROMIS Fatigue Scale), depressive symptoms (Center for Epidemiological Studies Depression survey), and physical functioning (Short Physical Performance Battery) scores. All biomarkers underwent natural-log transformation.

RESULTS

There were 446 participants (mean age: 78 y ± 5; 44% women). In adjusted analyses, NT-proBNP was associated with AF-fatigue (β: 0.11, 95% CI: 0.03, 0.19), increased depressive symptoms (β: 0.44, 95% CI: 0.19, 0.70), and decreased physical function (β: -0.48, 95% CI: -0.72, -0.23). Hs-TnT was also associated with elevated AF-fatigue (β: 0.24, 95% CI: 0.09, 0.39) along with decreased physical function (β: -1.19, 95% CI: -1.64, -0.75). No significant associations were found with hsCRP and fatigue.

CONCLUSION

Increased levels of cardiac injury biomarkers, depressive symptoms, and decreased physical function were associated with AF-fatigue. Inflammation was not associated with AF-fatigue; other physiological pathways, such as cardiac overload or myocardial injury may be more relevant in AF-fatigue.

Factors associated with postpartum fatigue: an exploration of the moderating role of resilience

Background

Postpartum fatigue (PPF) can impair the physical and mental well-being of women. The aims of this study were to assess the associations between fatigue and maternal health-related variables, specifically, sleep quality, depression symptoms, and resilience, and to explore the moderating role of resilience in the relationships between sleep quality, depression symptoms, and fatigue.

Methods

This cross-sectional study used data collected from mothers during the postpartum period via an online platform. PPF was assessed using the Fatigue Severity Scale, whereas sleep quality and depression symptoms were assessed using the Pittsburgh Sleep Quality Index and Edinburgh Postnatal Depression Scale, respectively. The Brief Resilience Scale was used to assess resilience. Simple and multiple binary logistic regression analyses were performed to examine the association of each independent variable with PPF and to determine the most significant predictors of PFF. The data were analyzed using SPSS, and structural equation modeling was performed using AMOS 23. A moderation analysis was performed to explore the moderating role of resilience using the Hayes PROCESS macro.

Results

A total of 1,443 postpartum mothers were included in the analysis. The simple binary logistic regression analysis showed that having chronic disease (odds: 1.52; p = 0.02), mother's age (odds: 0.97; p = 0.03), mother's body mass index (BMI; odds: 1.03; p = 0.01), depression symptoms (odds: 1.09; p ≤ 0.0001), sleep quality (odds: 1.17; p ≤ 0.0001), and resilience (odds: 0.42; p ≤ 0.0001) all contributed to fatigue during postpartum. Multivariate logistic regression showed that the mother's BMI, sleep quality, depression symptoms, and resilience were significant predictors of PPF. Moderation analyses showed that resilience was not a significant moderator between the main effects of sleep quality and fatigue (interaction effect: β = 0.01, p = 0.31, 95% CI: -0.01 to 0.04) or between the main effects of depression symptoms and fatigue during postpartum (interaction effect: β = 0.01, p = 0.82, 95% CI: -0.01 to 0.02).

Conclusion

Given the deleterious effects of PPF on maternal health outcomes, factors associated with PPF should be assessed regularly. In addition to mothers' BMI, sleep quality, and depression symptoms, resilience could also be a crucial factor in predicting fatigue severity during this critical time for mothers even though it was not a significant moderator among this sample.

Comparison of fatigue and functional status in elderly type 2 diabetes patients versus age and gender matched individuals

Introduction

Fatigue is a common yet not frequently explored complication of diabetes. There are fewer studies available on the impact of diabetes on the severity of fatigue and the functional status of patients.

Methods

Fifty individuals meeting the inclusion criteria were included. The individuals were divided into two groups: group A (diabetic elderly individuals) and group B (nondiabetic age and gender-matched individuals). An observational analytical study was conducted. Outcome measures used were: fatigue severity scale (FSS), lower extremity functional scale (LEFS), 6-minute walk distance (6MWD), and 30-second chair stand test. SPSS 16 was used to analyze data.

Results

As per the normality test, a between-group comparison of fatigue severity scale (FSS) score, chair stand test score, and LEFS score was carried out by a nonparametric Mann-Whitney test, which showed a statistically significant difference between the groups (P < 0.05). Between-group comparison of 6MWD was carried out by parametric unpaired t test. The results showed a statistically significant difference in the distance walked by both groups.

Conclusion

Higher levels of fatigue and impaired functional status along with reduced strength and function of lower limbs was seen in elderly patients with type 2 diabetes Inclusion of symptom assessment and strategies to reduce the burden of fatigue in diabetes patient should be incorporated.

Utilizing a quality of life tool to examine the presence of fatigue in subjects with diabetes mellitus

Introduction

The prevalence of fatigue in patients with diabetes mellitus (DM) can be as high as 50 %. Physical, mental, and psychosocial components of fatigue negatively impact quality of life (QOL), morbidity and mortality. Several tools have been developed to address fatigue, but none specifically for measuring fatigue in DM. The aim of this study was to assess the impact of diabetes and neuropathy on fatigue using the Norfolk QOL-Fatigue (QOL-F) survey.

Methods

605 adult participants from [Anonymous] were recruited (400 subjects with type 1 or type 2 DM and 205 subjects without diabetes (controls)). All subjects completed the Norfolk QOL-F. Demographics, weight, BMI, and duration of diabetes were obtained. The Norfolk QOL-F, a 35-item validated questionnaire, assesses five domains: subjective fatigue, physical and cognitive fatigue, reduced activities, impaired activities of daily living, and depression.

Results

Subjects with DM reported significantly higher fatigue total scores (52.63vs33.89, p < 0.0001) and in all five domains when compared to controls. Patients with DM with neuropathy were significantly more fatigued than those without (59.72vs27.83, p < 0.0001). Fatigue scores in patients with DM without neuropathy were similar to controls (27.83vs33.89, p = NS). In multivariate analysis, age, gender, and presence of neuropathy significantly impacted fatigue scores.

Conclusions

The Norfolk QOL-F questionnaire can potentially identify the impact of chronic diseases such as diabetes on fatigue. Assessing the different components of fatigue is important for clinicians in improving disease management and outcomes. Further investigations are needed to confirm these observations in specific cohorts with other comorbidities.

Impact of Fatigue and Its Influencing Factors on Diabetes Self-Management in Adults With Type 2 Diabetes: A Structural Equation Modeling Analysis

PURPOSE

The purposes of this study were to (1) examine the relationships between fatigue, its influencing factors, and diabetes self-management and (2) test the mediation effects of fatigue on the link between the influencing factors and diabetes self-management in adults with type 2 diabetes.

METHODS

This cross-sectional, correlational study was guided by the theory of unpleasant symptoms. Data were collected using structured questionnaires. Fatigue was measured by the Fatigue Symptom Inventory and the Multidimensional Fatigue Inventory. Diabetes self-management was measured by the Summary of Diabetes Self-Care Activities. From March to July 2021, a convenience sample of 150 participants was recruited from 2 diabetes outpatient clinics of a regional hospital in Taiwan. Data were analyzed using structural equation modeling.

RESULTS

A more recent diagnosis of diabetes, more depressive symptoms, and lower sleep quality were related to higher fatigue. Higher fatigue correlated with less performance in diabetes self-management. Fatigue mediated the relationship between depressive symptoms, sleep quality, and diabetes self-management.

CONCLUSIONS

Fatigue had a mediating effect on the link between psychological influencing factors and diabetes self-management. Future development of fatigue interventions integrating depressive symptoms and sleep management will likely increase the performance of diabetes self-management and improve the health outcomes in adults with type 2 diabetes. The study tested the theory of unpleasant symptoms using empirical data and will assist in building theory-guided fatigue interventions to improve diabetes self-management in people with type 2 diabetes.

A structural equation model in adults with type 1 and 2 diabetes: exploring the interplay of psychological states and diabetes outcomes, and the mediating effect of resilience

AIMS

Type 1 and 2 diabetes mellitus (T1DM and T2DM) can lead to emotional distress and cognitive impairments, often caused by psychological factors such as low mood or anxiety; yet, few studies have explored the theoretical mechanisms underlying these relationships and within one study. This study explored the relationships between psychological states (anxiety/worry, fatigue) and diabetes outcomes (diabetes distress, cognitive dysfunction), and whether resilience mediated the association between these in T1DM and T2DM.

METHODS

A sample of 307 UK adults with a clinical diagnosis of diabetes (T1DM = 129; T2DM = 178) completed a cross-sectional online survey, composed of six questionnaires. Associations between variables were investigated using Pearson's correlations and Structural Equation Modelling (SEM).

RESULTS

Psychological states were significantly correlated with diabetes outcomes, and resilience was significantly related to both psychological states and diabetes outcomes. The SEM model achieved an acceptable model fit with a significant mediating effect of resilience between psychological states (anxiety/worry, fatigue) and diabetes outcomes (diabetes distress, cognitive dysfunction), with no significant differences between diabetes type.

CONCLUSIONS

We propose a new theoretical model of T1DM and T2DM that could be used to provide guidance for those designing interventions. These findings help to understand the complex nature of diabetes management, suggesting resilience could be a key factor in managing psychological states and diabetes outcomes.

Fatigue following type 2 diabetes: Psychometric testing of the Indonesian version of the multidimensional fatigue Inventory-20 and unmet fatigue-related needs

Patients with type 2 diabetes mellitus (T2DM) often experience fatigue. The Multidimensional Fatigue Inventory (MFI-20) is a valid tool for evaluating fatigue; however, its psychometric properties have not been examined in Indonesian-speaking patients with T2DM. This study assessed the psychometric properties of the Indonesian version of the Multidimensional Fatigue Inventory-20 (IMFI-20) in patients with T2DM and investigated fatigue in a health-care setting. A cross-sectional design was adopted. Two hundred patients with T2DM were interviewed in clinics. Five self-structured measures were used to assess the frequency and duration of fatigue and the health-care utilization of patients with fatigue. Cronbach's alpha and intraclass correlation (ICC) were used to evaluate the internal consistency and test-retest reliability of the Indonesian version of the MFI-20 (IMFI-20). The criterion, convergent, and known-group validity of the IMFI-20 were also examined, and its underlying structure was determined using explanatory factor analysis. The STROBE checklist was used. The results revealed that approximately half of the patients experienced fatigue. Among those with fatigue, 62% reported that their fatigue was rarely or never treated by their physicians. The IMFI-20 exhibited satisfactory model fit, excellent internal consistency (Cronbach's alpha of 0.92), and test-retest ICC of 0.93. The IMFI-20 was significantly associated with the Functional Assessment of Chronic Illness Therapy-Fatigue, Beck Depression Inventory-Second Edition, and Pittsburgh Sleep Quality Index (r = 0.705, 0.670, and 0.581, respectively). The IMFI-20 exhibited known-group validity for unfavorable sleep quality and HbA1C ≥ 6.5%. Our findings suggest that patients with T2DM who experience fatigue are often overlooked by health-care providers, and that the IMFI-20, which exhibits excellent psychometric properties, can be adopted by studies that use fatigue as an endpoint in Indonesian-speaking populations.

Resilience-based Islamic program as a promising intervention on diabetes fatigue and health-related quality of life

Psychological problems commonly experienced by patients with type 2 diabetes mellitus (T2DM) cause diabetes fatigue conditions that can further worsen the treatment prognosis. We conducted this investigation to determine the effectiveness of a resilience-based Islamic program on diabetes fatigue and health-related quality of life (HRQoL) by measuring the biochemical indicators of T2DM. This was a quasi-experimental study performed from May to August 2021, in which 80 respondents aged 18–64 years diagnosed with T2DM were included through purposive sampling at a male:female sex ratio of 1:1 in the control group and 17:23 in the treatment group. A resilience-based Islamic program (a combination of stress management, mindfulness, prayer, and dhikr (the ritual formula of Sufi brotherhood recited devotionally in praise of Allah and as a means of attaining ecstatic experience)) was implemented in the treatment group for six sessions by blended online and offline interventions. Multidimensional Fatigue Inventory-20 and World Health Organization Quality of Life, Brief Form were used to evaluate diabetes fatigue and HRQoL. Blood tests were performed to measure HbA1c, total antioxidant serum, insulin, cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) levels from baseline to 3 months. Statistical analyses were conducted using paired t test, Wilcoxon signed-rank test, independent t test, and Mann–Whitney U test. The resilience-based Islamic program had a beneficial impact on the levels of HbA1c (p < 0.001), lipid profile (triglyceride) (p = 0.011), HDL-c (p = 0.01), LDL-c (p < 0.001), total antioxidant serum (p = 0.001), insulin (p < 0.001), diabetes fatigue (p < 0.05), and HRQoL (p < 0.05) in patients of the treatment group. The results of biochemical tests related to T2DM also indicated a reduction in diabetes fatigue and an increase in HRQoL due to the resilience-based Islamic program. Considering that a patient’s resilience to diabetes is an important factor in the management of diabetes fatigue, the resilience-based Islamic program can be applied at public health centers and community levels to increase T2DM resilience.

Prevalence and risk factors of fatigue in type 1 and type 2 diabetes: A systematic review and meta-analysis

PURPOSE

This meta-analysis was conducted to determine the prevalence and risk factors of fatigue in type 1 and type 2 diabetes mellitus (DM).

METHODS

Observational studies reporting the prevalence and risk factors of fatigue in type 1 or 2 DM were systematically searched for in PubMed, Embase, CINAHL Plus, Cochrane Trial, and ProQuest Dissertation and Theses databases. Data were extracted by two independent reviewers. A random-effect model was used for data analysis.

FINDINGS

We included 19 studies involving 7131 patients with type 1 DM and 32 studies involving 34,994 patients with type 2 DM in the study. The pooled prevalence of fatigue in type 1 and type 2 DM was 44% and 50%, respectively. The Asia-Pacific region (e.g., Japan and Australia), South America, and Africa lacked reports regarding fatigue prevalence in type 1 DM, and North Asia and Southeast Asia lacked reports of fatigue prevalence in type 2 DM. Depression and physical activity were the only two variables significantly correlated with fatigue in both type 1 and type 2 DM (all p < 0.05).

CONCLUSIONS

Approximately half of the patients with type 1 or type 2 DM experienced fatigue, with the prevalence of 44% and 50%, respectively. Our findings regarding its risk factors can provide an evidence-based approach for managing fatigue in DM patients.

CLINICAL RELEVANCE

This meta-analysis emphasizes the importance of fatigue management in patients with type 1 and type 2 DM. Most significantly, our results on risk factors related to fatigue in diabetes can contribute to the development of evidence-based strategies for managing fatigue in individuals with DM.

An integrative review of fatigue in adults with type 2 diabetes mellitus: Implications for self-management and quality of life

AIMS AND OBJECTIVES

To synthesise empirical studies on factors related to fatigue and its impact on diabetes self-management (DSM) and quality of life (QOL) in adults with type 2 diabetes mellitus (T2DM).

BACKGROUND

Fatigue is commonly reported in people with T2DM, a chronic condition that is highly prevalent worldwide. However, a holistic understanding of the consequences and factors related to fatigue in adults with T2DM is not well synthesised.

DESIGN

This integrative review used Whittemore and Knafl's methodology and was reported according to the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist.

METHODS

The theory of unpleasant symptoms (TOUS) was used as a conceptual model to guide the review. The PubMed, PsychINFO and CINAHL databases were searched to identify studies that recruited adults with T2DM, were peer-reviewed, written in English and investigated fatigue as a primary or secondary outcome. Two investigators independently appraised the quality of the studies and extracted the data.

RESULTS

Twenty-nine articles met the inclusion criteria: 23 observational studies, two randomised controlled trials, one quasi-experimental study and three qualitative studies. All articles were of high quality. Physiological (e.g. T2DM duration, complications and inflammatory biomarkers), psychological (e.g. diabetes distress, depression and sleep quality) and situational factors (e.g. race/ethnicity, education and social support) were related to fatigue. Studies reported fatigue as a barrier to physical activity, healthy eating behaviours and the physical aspect of QOL.

CONCLUSIONS

Multiple factors are related to fatigue in adults with T2DM. Gaps in the literature include the multiple dimensions of fatigue, the effectiveness of interventions to alleviate fatigue and fatigue experiences in under-represented populations.

RELEVANCE TO CLINICAL PRACTICE

This integrative review supports the complex origin of fatigue and its impact on adults with T2DM. Nurses should evaluate modifiable factors related to fatigue and provide support to help improve DSM and QOL in this population.

Contributing factors of fatigue in patients with type 2 diabetes: A systematic review

Remarkable evidence supports the link between type 2 diabetes (T2DM) and fatigue. However, a unifying recommendation to identify and prevent fatigue or to prevent its clinical consequences in T2DM is not available at present. Therefore, this study aimed to conduct a systematic review to summarize the definition, measurement tools, and contributing factors of fatigue in T2DM. Nine articles were included for analysis, and results showed that T2DM fatigue was associated with five major factors, including sociodemographic factors, clinical disease factors, inflammatory factors, psychological factors, and behavior and lifestyle. The contributing factors of T2DM fatigue are reviewed, and clinical benefits provide a theoretical basis for further clinical intervention to prevent the occurrence of fatigue and improve the patient's treatment compliance and self-management ability and may be beneficial to their quality of life.

Fluctuations in Self-Reported Symptoms Predict Objective Physical Activity in Adults With Type 2 Diabetes

PURPOSE

The purpose of this study was to examine the association between self-reported symptoms including fatigue and sleep disturbance with moderate-intensity physical activity among adults with type 2 diabetes.

METHODS

This report was a secondary analysis of a cross-sectional study. Data from 53 participants with at least 6 days of repeated measures were used. Daytime physical activity and energy expenditure were assessed using a wrist-worn accelerometer at the free-living setting. Fatigue upon awakening was measured using a 0 to 10 scale. Sleep (eg, restorative sleep, sleep duration, and sleep efficiency) was measured using the Consensus Sleep Diary for Morning. Data were analyzed using linear mixed models by including within- and between-person effects.

RESULTS

Participants were predominantly females (54.7%) with a mean age of 60.3 years. Controlling for the covariates, at the individual level (within-person), fluctuations in restorative sleep and fatigue upon awakening predicted moderate-intensity PA. Similarly, at the individual level, fluctuations in restorative sleep and fatigue upon awakening predicted average hourly energy expenditure. However, at the group level (between-person), no significant associations were found between fatigue and restorative sleep with moderate-intensity physical activity.

CONCLUSIONS

The study findings suggest that within-person fluctuations in fatigue and restorative sleep upon awakening predict daytime moderate-intensity physical activity. At the individual level, reducing fluctuations in fatigue and restorative sleep might encourage participation in physical activity. More research is warranted to uncover the underlying causes of fluctuations in fatigue and restorative sleep. Meanwhile, diabetes care and education specialists should pay attention to the within-person fluctuations of fatigue and sleep.

A Moderated-Mediation Model of the Relationship between Dietary Satisfaction and Fatigue in Older Adults with Diabetes: The Role of Meal Planning and Depressive Symptoms

Little research has examined the pathways between psychological factors and fatigue in older adults with diabetes. This study explored the pathways between diet-related quality of life and depressive symptoms in predicting fatigue using a moderated-mediation model. A convenience sample of adults ≥65 years (n = 127) with diabetes completed a cross-sectional survey including measures of fatigue severity, diet-related quality of life, and depressive symptoms, and a moderated-mediation analysis assessed the relationships between them. Diet satisfaction was negatively related to fatigue, which was mediated by depressive symptoms. In the moderated-mediation model, diet satisfaction had a conditional effect on fatigue through the mediating effect of depressive symptoms, moderated by meal planning difficulty. At higher levels of perceived meal planning difficulty, lower diet satisfaction was indirectly associated with higher fatigue through depressive symptoms, but this pathway was non-significant at lower levels. Findings suggest that supportive care for diet therapy might improve psychological outcomes in older adults with diabetes, especially for those having difficulties with daily dietary practice. Meal planning difficulties in the dietary management of diabetes accompanied by low diet satisfaction may lead to negative psychological outcomes. Monitoring satisfaction and burdens associated with dietary practices could improve fatigue in this population.

Physical activity and its associated factors in females with type 2 diabetes in Riyadh, Saudi Arabia

Despite the benefits of physical activity (PA) for the management of type 2 diabetes Mellitus (T2DM), the topic of PA is poorly addressed in Saudi Arabia (SA), especially in females with T2DM. The present study examined PA and its associated factors in females with T2DM in Riyadh, Saudi Arabia. This observational cross-sectional study was performed in a random sample of 372 women with T2DM. A face-to-face interview that covered PA, health and environmental correlates of PA was performed. Discriminant analysis was used to determine which barriers had the greatest impact on PA in these women. The results showed that approximately 26.3% of the study participants met PA recommendations. Multivariate linear regression revealed lower levels of PA were associated with women who had more than three children (β = -0.17) compared to women with no children, older age (β = -0.18), women with a duration of diabetes ≥ 6 years (β = -0.16), women who were obese (β = -0.23), women with no family support (β = -0.20), no friend support (β = -0.13) and no healthcare provider support (β = -0.14). Discriminant analysis indicated that culture and tradition, lack of skills and knowledge, safety, fatigue, lack of time, weather conditions, and lack of facilities were the barriers that differentiated between the women who met and those who did not meet the PA recommendations. The present study suggests that the prevalence of PA is low and number of children, age, duration of diabetes, Obesity, family support, friend support and healthcare provider support are identified correlates of PA. These findings are valuable and should be used to design and implement future PA interventions, especially for women with T2DM. Healthcare providers may improve exercise levels and identify the specific barriers to reaching the recommended level of PA to improve health outcomes for each patient.

Real-Time Associations Between Glucose Levels and Fatigue in Type 2 Diabetes: Sex and Time Effects

OBJECTIVE

Fatigue is a pervasive and serious complaint among aging adults with type 2 diabetes. Anecdotally, hyperglycemia was thought to cause fatigue, but prior cross-sectional analyses failed to find any relationship between glucose levels and fatigue. However, study methodology may have caused this relationship to be missed. Our aim was to use concurrent and continuous data across 5 days to examine real-time momentary relationships between glucose and fatigue levels by week, day, and time of day. Additionally, we explored how these relationships differed by sex.

METHOD

Participants (N = 54, 51% male, 54% non-White) wore continuous glucose monitors and wrist actigraphy into which they inputted fatigue ratings 6-8 times daily during waking hours across 5 days. Generalized estimation equation models were used to explore the relationship between glucose and fatigue when averaged by week, day, and time of day. Differences by sex were also explored.

RESULTS

HbA1c and baseline and real-time fatigue were higher in women than in men. Baseline HbA1c and self-reported general fatigue were unrelated. Fatigue levels averaged by day and time of day were higher in women than in men (p < .05). Glucose and fatigue were significantly related at all levels of data (weekly, daily, and time of day) in women but not men.

CONCLUSIONS

Our findings suggest that, when measured concurrently, glucose excursions may affect fatigue levels in women.

MUSCLE MITOCHONDRIAL CAPACITY AND ENDURANCE IN ADULTS WITH TYPE 1 DIABETES

The impact of type 1 diabetes (T1D) on muscle endurance and oxidative capacity is currently unknown.

Purpose

Measure muscle endurance and oxidative capacity of adults with T1D compared to controls.

Methods

A cross-sectional study design with a control group was used. Subjects (19-37 years old) with T1D (n=17) and controls (n=17) were assessed with hemoglobin A1c (HbA1c) and casual glucose. Muscle endurance was measured with an accelerometer at stimulation frequencies of 2, 4, and 6 Hz for a total of nine minutes. Mitochondrial capacity was measured using near-infrared spectroscopy after exercise as the rate constant of the rate of recovery of oxygen consumption.

Results

T1D and control groups were similar in age, sex, height, and race. The T1D group had slightly higher BMI values and adipose tissue thickness over the forearm muscles. Casual glucose was 150±70 mg/dL for T1D and 98±16 mg/dL for controls (P=0.006). HbA1c of T1D subjects was 7.1±0.9% and 5.0±0.4% for controls (P<0.01). Endurance indexes at 2, 4, and 6 Hz were 94.5±5.2%, 81.8±8.4%, and 68.6±13.5% for T1D and 94.6±4.1%, 85.9±6.3%, and 68.7±15.4% for controls (p = 0.97, 0.12, 0.99, respectively). There were no differences between groups in mitochondrial capacity (T1D= 1.9±0.5 min^-1 and control=1.8±0.4 min^-1, P=0.29) or reperfusion rate (T1D= 8.8±2.8s and control=10.3±3.0s, P=0.88). There were no significant correlations between HbA1c and either muscle endurance, mitochondrial capacity or reperfusion rate.

Conclusions

Adults with T1D did not have reduced oxidative capacity, muscle endurance or muscle reperfusion rates compared to controls. HbA1c also did not correlate with muscle endurance, mitochondrial capacity or reperfusion rates. Future studies should extend these measurements to older people or people with poorly-controlled T1D.

The Effect of Symptom Clusters on Quality of Life Among Patients With Type 2 Diabetes

Purpose

The purpose of this study was to examine the collective effect of a symptom cluster (depression, anxiety, fatigue, and impaired sleep quality) at baseline on the quality of life (QOL) of patients with type 2 diabetes (T2DM) over time.

Methods

This was a secondary data analysis of 302 patients with T2DM who presented with both hypertension and hyperlipidemia. All of the participants were enrolled in a randomized controlled intervention study testing strategies to improve medication adherence. The psychological symptoms and QOL were assessed at baseline, 6 months, and 12 months. Cluster analysis was used to identify subgroups of patients based on the severity of symptoms at baseline.

Results

Hierarchical cluster analysis identified 4 patient subgroups: all low severity, mild, moderate, and all high severity. There were significant differences in patients’ QOL overall among the 4 subgroups. Compared with the all-low-severity subgroup, subgroups with higher severity of the 4 symptoms had poorer QOL across all 3 time points. QOL was most impacted by trait anxiety across the 3 time points.

Conclusion

QOL was significantly impacted by psychological symptom clusters among patients with T2DM. Healthcare providers should not neglect psychological symptoms that patients experience. It is important to assess and manage these symptoms to improve QOL among patients with diabetes.

Exploring how patients understand and assess their diabetes control

BACKGROUND

Poor understanding of diabetes management targets is associated with worse disease outcomes. Patients may use different information than providers to assess their diabetes control. In this study, we identify the information patients use to gauge their current level of diabetes control and explore patient-perceived barriers to understanding the hemoglobin A1c value (HbA1c).

METHODS

Adults who self-reported a diagnosis of diabetes were recruited from outpatient, academically-affiliated, Internal Medicine clinics. Semi-structured interviews were conducted with participants and collected data were analyzed using thematic analysis.

RESULTS

The mean age of the 25 participants was 56.8 years. HbA1c was one of several types of information participants used to assess diabetes control. Other information included perceived self-efficacy and adherence to self-care, the type and amount of medications taken, the presence or absence of symptoms attributed to diabetes, and feedback from self-monitoring of blood glucose. Most participants reported familiarity with the HbA1c (22 of 25), though understanding of the value's meaning varied significantly. Inadequate diabetes education and challenges with patient-provider communication were cited as common barriers to understanding the HbA1c.

CONCLUSIONS

In addition to the HbA1c, several categories of information influenced participants' assessments of their diabetes control. Increased provider awareness of the factors that influence patients' perceptions of diabetes control can inform effective, patient-centered approaches for communicating vital diabetes-related information, facilitating behavior change towards improved patient outcomes.

Diabetes Fatigue Syndrome

In this editorial we propose a condition that we refer to as 'diabetes fatigue syndrome' (DFS), which is commonly encountered in clinical practice. We define DFS as a multifactorial syndrome of fatigue or easy fatigability that occurs in persons with diabetes. It may be caused by a variety of lifestyle, nutritional, medical, psychological, glycemia/diabetes-related, and endocrine and iatrogenic factors. The authors share clinical pearls which can help the diabetes healthcare provider diagnose DFS, identify its etiologic factors and manage the syndrome. The editorial highlights the need to focus on symptomatic well-being in diabetes, along with efforts to achieve numerical targets.

Validity and reliability of functional assessment of chronic illness treatment-fatigue scale in Turkish patients with type 2 diabetes

BACKGROUND

A long-term diabetic complication, fatigue, which is a direct result of treatment and psychological processes, is a common symptom in diabetic individuals.

AIMS

To determine the reliability and validity of Functional Assessment of Chronic Illness Treatment-Fatigue Scale in Turkish patients with type 2 diabetes.

STUDY DESIGN

A methodological study.

METHODS

The sample consisted of 133 patients with type 2 diabetes who agreed to participate in the study and met the criteria for the study. Data were collected using the descriptive information form prepared by the researcher and the Scale obtained from FACIT System. The research data were collected by face-to-face interviews with the patients. Language and content validity of the Turkish version of the Scale was provided, Cronbach's Alpha coefficient, test-retest analysis and item analysis methods were used as reliability analysis.

RESULTS

The total Cronbach Alpha coefficient of the scale was found to be 0.92. According to the results of factor analysis, unlike the original scale, two sub-dimensions emerged in the Turkish version of the scale.

CONCLUSIONS

As a result of the validity and reliability analysis of the FACIT-Fatigue Scale, it can be said that it provides psychometric measures that can be used to determine the level of fatigue of type 2 diabetes patients in Turkish society.

Fatigue in Type 2 Diabetes: Impact on Quality of Life and Predictors

Fatigue is a persistent symptom, impacting quality of life (QoL) and functional status in people with type 2 diabetes, yet the symptom of fatigue has not been fully explored. The purpose of this study was to explore the relationship between fatigue, QoL functional status and to investigate the predictors of fatigue. These possible predictors included body mass index (BMI), Hemoglobin A1C (HbA1C), sleep quality, pain, number of complications from diabetes, years since diagnosis and depression. Forty-eight individuals with type 2 diabetes (22 females, 26 males; 59.66±7.24 years of age; 10.45 ±7.38 years since diagnosis) participated in the study. Fatigue was assessed by using Multidimensional Fatigue Inventory (MFI-20). Other outcomes included: QoL (Audit of Diabetes Dependent QoL), and functional status (6 minute walk test), BMI, HbA1c, sleep (Pittsburg sleep quality index, PSQI), pain (Visual Analog Scale), number of complications, years since diagnosis, and depression (Beck's depression Inventory-2). The Pearson correlation analysis followed by multivariable linear regression model was used. Fatigue was negatively related to quality of life and functional status. Multivariable linear regression analysis revealed sleep, pain and BMI as the independent predictors of fatigue signaling the presence of physiological (sleep, pain, BMI) phenomenon that could undermine health outcomes.

Severe fatigue in type 1 diabetes: Exploring its course, predictors and relationship with HbA1c in a prospective study

AIMS

To prospectively identify the course of severe fatigue, its predictors and the relationship with HbA_1c in patients with type 1 diabetes.

METHODS

214 adult patients completed questionnaires on fatigue severity and fatigue-related factors at baseline. HbA_1c was retrieved from medical records. After 43months, fatigue severity and HbA_1c were reassessed in 194 patients. A logistic regression analysis was used to determine predictors of severe fatigue at follow-up with various cognitive-behavioral and clinical factors as potential predictors. The relationship between fatigue and HbA_1c was investigated in a sub-analysis by differentiating between patients with suboptimal glucose control [HbA_1c>7% (53mmol/mol)] and optimal glucose control [HbA_1c⩽7% (53mmol/mol)].

RESULTS

The prevalence of severe fatigue was 40% at baseline and 42% at follow-up. In three out of four severely fatigued patients at baseline (76%), severe fatigue persisted over time. More depressive symptoms, more pain, sleep disturbances, lower self-efficacy concerning fatigue, less confidence in diabetes self-care, more fatigue severity at baseline and more diabetes complications predicted severe fatigue at follow-up. Over time, HbA_1c at baseline was positively associated with fatigue severity at follow-up in both groups (suboptimal glucose control: r=.18, p<.05; optimal glucose control: r=.09, p<.05).

CONCLUSIONS

About three quarters of fatigued[corrected] patients with type 1 diabetes suffer from persistent fatigue. Aside from the number of diabetes complications, no clinical factors explained the persistence of fatigue. HbA_1c and fatigue were weakly associated in a sub-analysis. Since the strongest predictors of severe fatigue were cognitive-behavioral factors, behavioral interventions might be effective in decreasing fatigue.

Effects of Physical Activity on Trace Elements and Depression Related Biomarkers in Children and Adolescents

Not much is known about the role of physical activity (PA), obesity related variables, and trace elements as potential risk factors affecting neurotransmitters in schoolchildren with depression. Our objective was to investigate the effect of physical activity (PA) on depressive symptoms in children and adolescents. Also, we aimed to study the association of demographic variables, serum levels of Copper (Cu), Zinc (Zn), serotonin, and salivary cortisol with depression in this population. One hundred and fifty school children (90 boys and 60 girls) aged 7-18 years were recruited for this study. All participants were evaluated for depression using CDI-score analysis. Their physical activity levels were checked using pre-validated questionnaires. The serum levels of Copper (Cu), Zinc (Zn), cortisol, and serotonin were estimated using atomic absorption, and immunoassay techniques. About 48.7 % of the study population had depressive symptoms (CDI-score; ≥13), and were classified into mild, moderate, and severe categories. Older children, especially girls, had higher levels of depression. Participants with moderate and severe depression had significantly lower physical activity, serotonin, and zinc levels, Zn/Cu ratios, and significantly higher copper and cortisol levels. Physically active boys showed significantly lower depressive CDI-scores and improvement in cortisol, serotonin, Cu, and Zn concentrations compared to girls of sedentary life style. CDI- scores correlated positively with BMI, cortisol and Cu, and negatively with PA, serotonin and Zn concentrations. BMI, cortisol, serotonin, Cu and Zn, could explain about 59.3-79 % of the depressive symptoms among schoolchildren, according to stepwise regression analysis. This was especially true in especially older girls. PA and an adequate balance in Zn and Cu levels, plays a positive role in improving CDI-depressive score, BMI, serotonin and cortisol levels among schoolchildren.

Aerobic exercises alleviate symptoms of fatigue related to inflammatory cytokines in obese patients with type 2 diabetes

BACKGROUND

Non-insulin dependent diabetic patients frequently suffer from fatigue symptoms that result from chronic systemic inflammation. Aerobic exercise was proved to modulate systemic inflammation.

OBJECTIVE

This study was an attempt to measure the impact of aerobic exercises on fatigue symptoms related to systemic inflammation in obese patients with type 2 diabetes.

METHODS

Eighty obese patients with type 2 diabetes participated in the present study, their age ranged from 40-58 years and their BMI ranged from 31-36 kg/m2 and were assigned to two subgroups; group (A) received aerobic exercise training for 12 weeks and group (B) received no exercise training for 3 months. Measurements of fatigue symptoms and markers of systemic inflammation were assessed before and at the end of the study for all participants in both groups.

RESULTS

The mean values of inflammatory markers (IL-6 and TNF-α) and Multidimensional Fatigue Inventory (MFI) was significantly decreased in group (A), while changes were not significant in group (B). Moreover, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) at the end of the study.

CONCLUSION

Treadmill walking exercise training is an effective treatment policy to improve symptoms of fatigue related to inflammatory cytokines in obese patients with type 2 diabetes.

Study of fatigue, depression, and associated factors in type 2 diabetes mellitus in industrial workers

INTRODUCTION

Type 2 diabetes mellitus is a significant health problem and imposes great physical, financial and psychological burden among the affected population. Among people with diabetes, fatigue is a pervasive and distressing complaint, which is further accentuated by presence of depression.

OBJECTIVE

To assess the prevalence of fatigue and depression and associated clinical and socio demographic correlates in type 2diabetes.

MATERIALS AND METHODS

This cross sectional study included 100 patients of diabetes type 2 and equal number of healthy controls between the ages of 18 to 70 years. A detailed evaluation of socio demographic and clinical parameters was made. Participants were also assessed for presence of depression and fatigue using PHQ-9 and Fatigue Severity Scale(FSS)respectively.

RESULTS

Fatigue and depression was found in 68 % and 53 % of diabetic participants. Diabetic patients were 10.37 times and 4.80 times more likely to suffer from fatigue and depression respectively. Both fatigue and depression were found to be significantly associated with duration of illness, fasting and post prandial blood glucose level, diabetic complications and Body Mass Index (BMI). Fatigue was also strongly correlated with depression in study sample.

CONCLUSIONS

Fatigue and depression are reasonably correlated with type 2 diabetes. Various clinical parameters of diabetes are strongly associated with both fatigue and depression. Fatigue itself has significant correlation with depression in type 2 diabetes. Regular monitoring of biochemical parameters are paramount to predict the development of fatigue and depression in type 2 diabetes.

Glucose control and fatigue in type 2 diabetes: the mediating roles of diabetes symptoms and distress

AIM

The purpose of this study was to examine the mediating influence of diabetes health characteristics (diabetes distress, depression symptoms and diabetes symptoms) on the relationship between glucose control and fatigue in adults with type 2 diabetes.

BACKGROUND

In patients with type 2 diabetes, fatigue is common and can affect diabetes self-management behaviours. Although long thought to result from hyperglycaemia, little evidence supports a relationship between fatigue and glucose control.

DESIGN

A cross-sectional, descriptive study design was used.

METHOD

Data were combined from two studies conducted at a large urban university in the Midwestern United States, resulting in a total sample of 155 urban-dwelling adults with type 2 diabetes. Data were collected over the course of 6 days from 2013-March 2014. Fatigue and related biological and psychological phenomena were measured to perform path analyses using structural equation modelling methods. The STATA software was used to analyse the data.

FINDINGS

In patients with A1C less than or equal to 7%, fatigue was related to diabetes distress and diabetes symptoms, but not to A1C directly or indirectly. In the group with A1C greater than 7%, fatigue was indirectly related to A1C; this relationship was mediated through diabetes symptoms, depression and diabetes distress.

CONCLUSION

Our findings suggest that fatigue is indirectly related to glucose control, but only in patients who have elevated A1C levels. In those with adequate glucose control, fatigue is mainly influenced by the presence of diabetes symptoms and distress. In both groups, the number and severity of diabetes symptoms were the strongest predictors of fatigue, regardless of blood glucose control.

Safety of aerobic exercise in people with diabetic peripheral neuropathy: single-group clinical trial

BACKGROUND

Exercise is recommended for people with diabetes, but little is known about exercise in people with diabetic peripheral neuropathy (DPN).

OBJECTIVE

The primary purpose of this preliminary study was to examine adverse events (AEs) during moderate-intensity, supervised aerobic exercise in people with DPN. The secondary purpose was to examine changes in fatigue, aerobic fitness, and other outcomes after intervention.

DESIGN

This was a single-group preliminary study.

SETTING

The setting was an academic medical center.

PARTICIPANTS

Participants were 18 people who were sedentary and had type 2 diabetes and peripheral neuropathy (mean age=58.1 years, SD=5).

INTERVENTION

The intervention was a supervised 16-week aerobic exercise program (3 times per week at 50% to >70% oxygen uptake reserve).

MEASUREMENTS

Adverse events were categorized as related or unrelated to the study, anticipated or unanticipated, and serious or not serious. Outcomes included fatigue (Multidimensional Fatigue Inventory), cardiovascular fitness (peak oxygen uptake), body composition (dual-energy x-ray absorptiometry), sleep quality, plasma metabolic markers, and peripheral vascular function.

RESULTS

During the study, 57 nonserious AEs occurred. Improvements were found in general fatigue (mean change=-3.5; 95% confidence interval [95% CI]=-1.3, -5.3), physical fatigue (mean change=-3.1; 95% CI=-1.2, -5.0), peak oxygen uptake (mean change=1.1 mL·kg(-1)·min(-1); 95% CI=0.2, 1.9), total body fat (mean change=-1%; 95% CI=-0.3, -1.7), fat mass (mean change=-1,780 g; 95% CI=-616.2, -2,938.7), and peripheral blood flow (mean change=2.27%; 95% CI=0.6, 4.0).

LIMITATIONS

This was a small-scale, uncontrolled study. A future randomized controlled trial is needed to fully assess the effects of exercise on the outcomes.

CONCLUSIONS

This study provides new support for supervised aerobic exercise in people with DPN. However, it is important for physical therapists to carefully prescribe initial exercise intensity and provide close monitoring and education to address the anticipated AEs as people who are sedentary and have DPN begin an exercise program.

Quality of life and illness perception in primary biliary cirrhosis: a controlled cross-sectional study

OBJECTIVE

The aim of this study was to understand better the quality of life (QOL) and illness perception in women with primary biliary cirrhosis (PBC) through a comparison with women having diabetes.

METHODS

One hundred and ninety-four women took part in this study: 130 with PBC, 64 with type 2 diabetes. They were administered the SF-12 to measure QOL and the Brief Illness Perception Questionnaire to assess representations of their illness. Analysis of covariance with bootstrapping was used to compare QOL and illness perception scores by controlling age and mean disease duration.

RESULTS

Physical QOL was significantly worse for women with PBC than for women with diabetes. Women with PBC felt their disease would last longer and reported more symptoms and concerns related to their disease than women with diabetes. Significant differences were also observed for causes: women with PBC mainly reported autoimmune, emotional, unknown/unlucky and medical causes whereas women with diabetes reported mostly lifestyle and hereditary causes. Marginally significant differences were observed regarding consequences on daily life, feeling of control over the disease and emotional responses, which were shown to be worse in PBC. Mental QOL, treatment control and overall understanding of the disease was similar in both groups.

CONCLUSIONS

This study shows that women with PBC have a worse QOL and somewhat different illness perception than women with diabetes. Further research could help understand PBC specificities better in order to improve patient care, especially if factors such as fatigue or rarity of the disease explain these results.

Diabetes symptoms and self-management behaviors in rural older adults

AIMS

To evaluate the demographic and health correlates of reporting diabetes symptoms, and the relationship between diabetes symptoms and self-management behaviors in rural older adults.

METHODS

Cross-sectional interviews were conducted with 489 African American, American Indian, and white female and male adults 60 years and older. Participants with diabetes were recruited from eight North Carolina counties. Participants completed the 34-item Diabetes Symptom Checklist (DSC). Associations of demographic and health characteristics with reported symptoms were evaluated. Multivariate linear regression models were used to examine the associations of DSC scores and diabetes self-management.

RESULTS

Participants had low scores on the DSC. They largely practiced appropriate diabetes self-management behaviors (self-foot checks, fruit and vegetable consumption, and self-monitoring blood glucose). Correlates of DSC included women having higher scores for hypoglycemia, psychological total, and fatigue dimensions. Neuropathic pain and vision dimensions were significantly associated with educational attainment. Most DSC dimensions were associated with ethnicity or economic status. Taking oral diabetes medicine was correlated with hyperglycemia; insulin use was associated with most DSC dimensions. HbA1c was not associated with any DSC dimension; diabetes duration >10 years was correlated with all dimensions except neuropathic pain and vision. Higher levels of psychological fatigue were significantly associated with fewer self-management behaviors.

DISCUSSION/CONCLUSIONS

Demographic and health characteristics are associated with reported symptoms. Fatigue is a symptom negatively associated with diabetes self-management behavior in older adults. Health care providers are uniquely positioned to assess patient symptoms and potential relationships with successful diabetes management.