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

Published Online: September 12th 2012 European Endocrinology, 2012;8(2):80-83 DOI: http://doi.org/10.17925/EE.2012.08.02.80
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 pharmacological and behavioural 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.,sup>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 standardised definition, measurement approach, or diagnostic criteria.

Patients with type 2 diabetes commonly experience fatigue, which may be incapacitating and adversely affect self-care regimens.,sup>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 standardised 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 may be is associated with higher body mass index (BMI),1,7,12 the presence of co-morbid conditions,7,13 depression,7 physical inactivity,1,7,14 sleep disturbances1,15,16 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 glycaemic 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 pharmacological and behavioural interventions in patients with type 2 diabetes to impact inflammation and fatigue.

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Disclosure

The authors have no conflicts of interest to declare.

Correspondence

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

Support

The authors thank Kevin Grandfield, Publication Manager for the University of Illinois at Chicago Department of Biobehavioral Health Science, for editorial assistance.

Received

2012-07-19T00:00:00

References

  1. Grandner MA, Patel NP, Perlis ML, et al., Obesity, diabetes, and exercise associated with sleep-related complaints in the American population, J Public Health, 2011;19:463–74.
  2. Weijman I, Ros WJ, Rutten GE, et al., Fatigue in employees with diabetes: Its relation with work characteristics and diabetes related burden, Occup Environ Med, 2003;60(Suppl. 1):i93–8.
  3. Cavelti-Weder C, Furrer R, Keller C, et al., Inhibition of IL-1beta improves fatigue in type 2 diabetes, Diabetes Care, 2011;34(10):e158.
  4. Adriaanse MC, Dekker JM, Spijkerman AM, et al., Health-related quality of life in the first year following diagnosis of type 2 diabetes: Newly diagnosed patients in general practice compared with screening-detected patients. the Hoorn Screening Study, Diabet Med, 2004;21(10):1075–81.
  5. Garcia AA, Symptom prevalence and treatments among Mexican Americans with type 2 diabetes, Diabetes Educ, 2005;31(4):543–54.
  6. Warren RE, Deary IJ, Frier BM, The symptoms of hyperglycaemia in people with insulin-treated diabetes: Classification using principal components analysis, Diabetes Metab Res, 2003;19(5):408–14.
  7. Fritschi C, Quinn L, Hacker ED, et al., Fatigue in women with type 2 diabetes, Diabetes Educ, 2012;38(5):662–72.
  8. Fritschi C, Quinn L, Fatigue in patients with diabetes: A review, J Psychosom Res, 2010;69(1):33–41.
  9. Wessely S, The epidemiology of chronic fatigue syndrome, Epidemiol Psichiatr Soc, 1998;7(1):10–24.
  10. Lasselin J, Laye S, Dexpert S, et al., Fatigue symptoms relate to systemic inflammation in patients with type 2 diabetes. Brain Behav Immun, 2012;26(8):1211–9.
  11. Lasselin J, Layé S, Barreau J, et al., Fatigue and cognitive symptoms in patients with diabetes: Relationship with disease phenotype and insulin treatment. Psychoneuroendocrinology, 2012;37(9):1468–78.
  12. Hlatky MA, Chung SC, Escobedo J, et al., The effect of obesity on quality of life in patients with diabetes and coronary artery disease, Am Heart J, 2010;159(2):292–300.

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