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 43 months, 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% (53 mmol/mol)] and optimal glucose control [HbA(1c) 6 7% (53 mmol/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 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. (C) 2016 Elsevier Ireland Ltd. All rights reserved.