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

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Published Online: Sep 12th 2012 European Endocrinology, 2012;8(2):80-83 DOI:
Authors: Cynthia Fritschi, Anne M Fink
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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.


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


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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Article Information:

The authors have no conflicts of interest to declare.


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


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




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  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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