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Fatigue in Adults with Type 2 Diabetes— An Overview of Current Understanding and Management Approaches

Published Online: September 14th 2012 US Endocrinology, 2012;8(2):84-87 DOI: http://doi.org/10.17925/USE.2012.08.02.84
Authors: Cynthia Fritschi, Anne M Fink
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Abstract:
Overview

Patients with type 2 diabetes often experience fatigue, which impacts their self-care and quality of life. There are few data supporting a relationship between fatigue and glucose homeostasis, but fatigue in type 2 diabetes has been associated with higher body mass index (BMI), depression, physical inactivity, sleep disturbances, and chronic low-grade inflammation. Although links between fatigue and inflammation are documented in other disease populations, little is known about inflammatory mechanisms specific to type 2 diabetes and associated treatment modalities for type 2 diabetes-related fatigue. Herein we review existing knowledge about fatigue in type 2 diabetes and potential pharmacologic and behavioral therapies.

Keywords

Type 2 diabetes, fatigue, inflammation, patient-reported outcomes, symptoms, management

Article:

Patients with type 2 diabetes commonly experience fatigue, which may be incapacitating and adversely affect self-care regimens.1–7 Fatigue is a perplexing problem for healthcare providers.8 Wessely suggests that because fatigue is a non-specific and universal symptom, chronic fatigue is challenging to diagnose and treat.9 Fatigue researchers do not have a standardized definition, measurement approach, or diagnostic criteria. Diabetes-related fatigue is assumed to correlate with alterations in glucose homeostasis, but few data support this hypothesis.3,7,10,11 Fatigue in type 2 diabetes is associated with higher body mass index (BMI),1,7,12 the presence of comorbid conditions,7,13 depression,7 physical inactivity,1,7,14 sleep disturbances,1,15,16 and elevated cytokines.3,10 Fritschi and Quinn recently provided a detailed review of the correlates of fatigue in diabetes, including conflicting findings regarding the relationship between fatigue and glycemic control.8

Type 2 diabetes is a disorder associated with chronic low-grade inflammation.17,18 Type 2 diabetes and insulin resistance, especially among obese patients, were linked to an increased production of pro-inflammatory cytokines (e.g., tumour necrosis factor alpha [TNF-α], monocyte chemoattractant protein-1 [MCP-1], interleukin-1β [IL-1β], interleukin-6 [IL-6]) from immune cells as well as increased acute phase reactants (e.g., C-reactive protein [CRP]). Pro-inflammatory cytokines and CRP were associated with high fatigue levels10,11,19,20 and depression and sleep disturbances in a variety of diseases.21–24 There is a considerable gap in the literature, however, about the treatment of fatigue secondary to type 2 diabetes. Anti-inflammatory therapies may ameliorate fatigue with type 2 diabetes. Thus, our discussion of fatigue interventions will focus on the few available pharmacologic and behavioral interventions in patients with type 2 diabetes to impact inflammation and fatigue.

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Article Information:
Disclosure

The authors have no conflicts of interest to declare.

Correspondence

Cynthia Fritschi, PhD, RN, University of Illinois at Chicago College of Nursing (MC 802), 845 South Damen Avenue, Chicago, IL 60612, US. E: Fritschi@uic.edu

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Type 2 diabetes, fatigue, inflammation, patient-reported outcomes, symptoms, management

Received

2012-07-19T00:00:00

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