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Diabetes Res Clin Pract. 2016 Nov;121:127-134. doi: 10.1016/j.diabres.2016.09.011. Epub 2016 Sep 21.

Severe fatigue in type 1 diabetes: Exploring its course, predictors and relationship with HbA1c in a prospective study.

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Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address:
Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, The Netherlands.
Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Medical Psychology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands.



To prospectively identify the course of severe fatigue, its predictors and the relationship with HbA1c in patients with type 1 diabetes.


214 adult patients completed questionnaires on fatigue severity and fatigue-related factors at baseline. HbA1c was retrieved from medical records. After 43months, fatigue severity and HbA1c 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 HbA1c was investigated in a sub-analysis by differentiating between patients with suboptimal glucose control [HbA1c>7% (53mmol/mol)] and optimal glucose control [HbA1c⩽7% (53mmol/mol)].


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, HbA1c 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).


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. HbA1c 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.


HbA(1c); Persistent fatigue; Predictors of fatigue; Prospective design; Type 1 diabetes

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