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

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

Methods: 214 adult patients completed questionnaires on fatigue severity and fatigue-related factors at baseline. HbA was retrieved from medical records. After 43months, fatigue severity and HbA 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 was investigated in a sub-analysis by differentiating between patients with suboptimal glucose control [HbA>7% (53mmol/mol)] and optimal glucose control [HbA⩽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 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 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.