Chronic fatigue in type 1 diabetes: highly prevalent but not explained by hyperglycaemia or glucose variability.

  1. Hans Knoop, PhD1
  1. 1Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre
  2. 2Department of Internal Medicine, Radboud University Nijmegen Medical Centre
  3. 3Division of Human Nutrition, Wageningen University
  4. 4Department of Medical Psychology, Radboud University Nijmegen Medical Centre
  1. Corresponding author: Dr. Hans Knoop, E-mail: j.knoop{at}


Objective Fatigue is a classical symptom of hyperglycemia, but the relationship between chronic fatigue and diabetes has not been systematically studied. We investigated prevalence, impact and potential determinants of chronic fatigue in patients with type 1 Diabetes Mellitus (DM1).

Research Design and Methods Out of 324 random selected DM1 outpatients, 214 participated in this cross-sectional observational study. Participants were compared with age- and sex-matched population based controls. Chronic fatigue, functional impairments, current health status, comorbidity, diabetes-related factors and fatigue-related cognitions and behaviors were assessed with questionnaires, HbA1c values and comorbidity with medical records. Sixty-six patients underwent continuous glucose monitoring combined with an electronic fatigue diary for five days. Acute fatigue and four glucose parameters were determined; mean, variability and relative time spent in hypo- and hyperglycemia.

Results DM1 patients were significantly more often chronically fatigued (40%; 95%CI: 34%-47%) compared to matched controls (7%; 95%CI 3%-10%; p<.001). Chronically fatigued patients had significantly more functional impairments. Fatigue was the most troublesome symptom. Age (Odds Ratio (OR): depression (OR: 28.0), pain (OR: .965), sleeping problems (OR: 1.02), low self-efficacy concerning fatigue (OR: .826) and physical inactivity (OR: .995) were significantly associated with chronic fatigue. Chronically fatigued patients spent slightly less time in hypoglycemia (proportion: .07± 0.06 versus .12± 0.10; p=.025). Glucose parameters were not related to acute fatigue.

Conclusions Chronic fatigue is highly prevalent and clinically relevant in DM1. Its significant relationship with cognitive-behavioral variables and weak association with blood glucose levels suggests that behavioral interventions could be helpful in managing chronic fatigue in DM1.

  • Received March 1, 2013.
  • Accepted August 11, 2013.

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