Prevalence and risk factors of fatigue in type 1 and type 2 diabetes: A systematic review and meta-analysis

Latent Profile Analysis of Fatigue Subtypes in Adults With Type 2 Diabetes

BACKGROUND

People with type 2 diabetes mellitus (T2DM) commonly report a higher fatigue intensity than the general population. However, effective fatigue management is lacking because little is known about other fatigue characteristics, including timing, distress, and quality, as well as the potential fatigue subtypes experienced in people with T2DM.

OBJECTIVE

This study aims to describe fatigue intensity, timing, distress, and quality and to identify fatigue subtypes in people with T2DM.

METHODS

This cross-sectional, descriptive study included a sample of 150 participants with T2DM recruited from two diabetes outpatient clinics in Taiwan. Fatigue intensity, timing, and distress were measured using the Fatigue Symptom Inventory. Fatigue quality was measured using the Multidimensional Fatigue Inventory. Fatigue subtypes were identified using a latent profile analysis.

RESULTS

Participants reported a mild fatigue intensity, experiencing fatigue for about 22% of the day with worse fatigue in the afternoon and evening and having mild disturbances. Three fatigue subtypes were identified. The "high/persistent fatigue with mild distress" subtype was characterized by high fatigue intensity and duration with severe general, physical, and mental fatigue that mildly interfered with functioning. The "moderate/frequent fatigue with minimal distress" group showed moderate levels of fatigue intensity and duration levels with intermediate of general, physical, and mental fatigue and minimal fatigue disturbances. The "no fatigue and distress" subtype was characterized by overall low fatigue scores.

DISCUSSION

We identified fatigue characteristics and subtypes in people with T2DM, providing insights into better fatigue management. People with T2DM reported having mild but persistent fatigue. The latent profile analysis revealed that fatigue is likely composed of a mixture of physical and mental components. Nurses should assess both the physical and the mental aspects of fatigue while addressing features of the fatigue characteristics in tailored management strategies to alleviate all aspects of fatigue in people with T2DM.

A Home-Based Behaviour Change Intervention With Sedentary Behaviour and Physical Activity in People With Stroke and Diabetes-A Feasibility and Safety Study

BACKGROUND AND PURPOSE

Stroke survivors with type 2 diabetes mellitus (DM) face heightened cardiovascular risks, which are exacerbated by sedentary behaviour (SB). Despite existing interventions, there remains a gap in the literature regarding effective strategies to reduce SB and increase physical activity (PA). The purpose of this study was to explore the feasibility and safety of the 12-week 'Everyday Life is Rehabilitation' (ELiR) intervention comprising recruitment, adherence, practicality, and implementation into everyday life.

METHODS

Single-group longitudinal intervention study with 1-week baseline, motivational interviews at weeks 1 and 6, and 12-week follow-up. Stroke survivors with DM (N = 14) were recruited from Neurovascular Center at Zealand University Hospital, Roskilde. The ELiR intervention is a theory-based intervention that focuses on healthcare professionals (HCP) consultations with stroke survivors with DM to address SB and PA. Primary outcomes were recruitment, adherence, completion of physical tests (accelerometer measurements), cognitive tests, and safety. Secondary outcomes were sedentary time and steps collected using an accelerometer and glycated haemoglobin (HbA1c) measurements.

RESULTS

23 participants were recruited, of whom two were readmitted, one withdrew consent before the baseline test, and six were not discharged with a physiotherapy rehabilitation plan within 1-7 hospitalisation days. The remaining 14 were included and completed the study with a median modified Rankin scale (mRS) score of 1. The ELiR intervention revealed high adherence. Three participants experienced falls, and two were hospitalised. These incidents were not related to the intervention. Future adjustments include modified inclusion criteria, SMS-reminders, and point-of-care HbA1c measurements.

DISCUSSION

The ELiR intervention was feasible and safe. Falls and serious adverse events are in line with previously reported risks. Self-reported questionnaires and clinical tests had low and moderate adherence, whereas accelerometers had high adherence. However, the small sample size limits generalisability, and adjustments to the ELiR intervention are suggested to improve usability in physiotherapy practice before testing in RCT studies to confirm these findings.

Prevalence and correlates of insomnia and fatigue in patients with type 2 diabetes in Jordan

OBJECTIVE

The present study examined the prevalence and correlates of insomnia and fatigue in patients with type-2 diabetes in Jordan.

METHODS

This was a cross-sectional online study involving a convenience sample of 390 patients with type-2 diabetes. Insomnia was assessed by the Insomnia-Severity Index (ISI-A) and fatigue by the Brief Fatigue Inventory (BFI-A).

RESULTS

Severe insomnia was present in 132 patients (33.8%), and was correlated with length of diabetes (diagnosis >5 years) (OR = 2.13, 95% CI = 1.19-3.81, P = 0.01), presence of uncontrolled diabetes (OR = 1.97, 95% CI = 1.45-2.69, P < 0.001), taking gabapentin (OR = 2.07, 95% CI = 1.07-4.01, P = 0.003), and age (<40 years) (OR = 0.30, 95% CI = 0.13-0.69, P = 0.005). Significant fatigue was also prevalent and correlated with gender (female) (B = 9.25, t = 4.48, P < 0.001), age (<40 years) (B = 7.56, t = 2.56, P = 0.01), a diagnosis of hypertension (B = 4.74, t = 2.03, P = 0.04), uncontrolled diabetes (B = 7.21, t = 4.82, P < 0.001), and taking a sulfonylurea (B = 8.03, t = 3.37, P < 0.001), carbamazepine (B = 10.93, t = 2.65, P = 0.008), or gabapentin (B = 12.60, t = 3.83, P < 0.001).

CONCLUSION

Given the high prevalence of insomnia and fatigue in this population, increased attention by primary healthcare providers to these symptoms in diabetic patients is warranted, particularly in developing countries such as Jordan.

Effects of Personalized DiaBetes TEXT Messaging Combined with Peer Support Education on Patients With Type 2 Diabetes: A Randomized Controlled Trial

BACKGROUND

To investigate the effects of personalized DiaBetes TEXT messaging combined with Peer Support Education (DB-TEXT+ PSE) on clinical outcomes in patients with type 2 diabetes.

METHODS

An assessor-blinded, three-arm randomized controlled trial recruited 84 participants between December 2022 and July 2023. Participants were randomly assigned to a DB-TEXT + PSE group, a DB-TEXT group, or a professional education program (PEP) group. Primary outcomes included glycated hemoglobin (HbA1c), fasting blood glucose (FBG) levels, and clinical remission rates, whereas secondary outcomes measured lipid profiles, fatigue, sleep quality, depression, and quality of life (QoL). Outcomes were assessed at baseline (T0), three months (T1), and six months (T2) postintervention.

RESULTS

Relative to PEP, personalized DB-TEXT + PSE and DB-TEXT alone led to significantly reduced HbA1c levels at T1 and decreased FBG levels at T1 and T2. Type 2 diabetes remission was achieved by 35.7% and 50% of the participants in the DB-TEXT + PSE group, by 17.9% and 25% in the DB-TEXT group, and by 3.7% and 3.7% in the PEP group at T1 and T2, respectively. Relative to the PEP, DB-TEXT + PSE led to significantly reduced TC levels, diastolic blood pressure (DBP), and systolic blood pressure (SBP) and improved sleep quality and QoL over time.

CONCLUSIONS

Personalized DB-TEXT + PSE is more effective at enhancing clinical outcomes, reducing fatigue, improving sleep quality, and improving quality of life in patients with type 2 diabetes than DB-TEXT alone and PEPs are. Educators can incorporate personalized DB-TEXT + PSE as a component of diabetes education programs and thereby integrate digital interventions and supplementary programs.

Cognition of the warning symptoms and risk factors for cancer among Chinese college students: a cross-sectional study based on a summer social practice activity

BACKGROUND

To investigate the cognition of cancer warning symptoms and cancer risk factors among Chinese college students, analyze the influencing factors, and explain the correlations between cancer cognition and cancer symptom discrimination, cancer fear and psychological distress.

METHODS

Chinese college students were recruited in this cross-sectional study funded by a summer social practice activity in Yunnan Province, China. Cognition rates of cancer warning symptoms and cancer risk factors were evaluated using Cancer Warning symptoms Cognition Questionnaire (CWSCQ) and Cancer Risk Factors Cognition Questionnaire (CRFCQ), respectively. Factors associated with cognition of cancer warning symptoms, and factors associated with cognition of cancer risk factors were evaluated using multiple linear regression analysis. Interactions between cancer cognition, cancer symptom discrimination, psychological distress, and cancer fear were evaluated by structural equation modeling.

RESULTS

There were 846 effective samples, with an effective rate of 80.9%. The cognition rates of cancer warning symptoms were from 47.9% to 84.4%, which were affected by cancer symptom discrimination, education, attitudes towards cancer screening, living expenses, drinking history, and ways to obtain cancer knowledge (p < 0.05). The cognition rates of cancer risk factors were from 46.3% to 91.3% in participants, which were affected by education, cancer symptom discrimination, psychological distress, attitudes towards cancer screening, life satisfaction, cancer history in relatives and friends, ways to obtain cancer knowledge, smoking history, and nursing history for cancer patients (p < 0.05). Cancer cognition and cancer symptom discrimination showed intermediary effects on psychological distress and cancer fear (p < 0.001).

CONCLUSIONS

The overall cancer cognition situation among Chinese college students is not optimistic, which highlights the necessity of improving the cancer health literacy among Chinese college students. With the increasing morbidity and mortality rates of cancer, it is necessary to raise awareness of early detection, and early treatment of cancer among the general public. Health education interventions are helpful to improve cancer health literacy.

Utilizing a quality of life tool to examine the presence of fatigue in subjects with diabetes mellitus

Introduction

The prevalence of fatigue in patients with diabetes mellitus (DM) can be as high as 50 %. Physical, mental, and psychosocial components of fatigue negatively impact quality of life (QOL), morbidity and mortality. Several tools have been developed to address fatigue, but none specifically for measuring fatigue in DM. The aim of this study was to assess the impact of diabetes and neuropathy on fatigue using the Norfolk QOL-Fatigue (QOL-F) survey.

Methods

605 adult participants from [Anonymous] were recruited (400 subjects with type 1 or type 2 DM and 205 subjects without diabetes (controls)). All subjects completed the Norfolk QOL-F. Demographics, weight, BMI, and duration of diabetes were obtained. The Norfolk QOL-F, a 35-item validated questionnaire, assesses five domains: subjective fatigue, physical and cognitive fatigue, reduced activities, impaired activities of daily living, and depression.

Results

Subjects with DM reported significantly higher fatigue total scores (52.63vs33.89, p < 0.0001) and in all five domains when compared to controls. Patients with DM with neuropathy were significantly more fatigued than those without (59.72vs27.83, p < 0.0001). Fatigue scores in patients with DM without neuropathy were similar to controls (27.83vs33.89, p = NS). In multivariate analysis, age, gender, and presence of neuropathy significantly impacted fatigue scores.

Conclusions

The Norfolk QOL-F questionnaire can potentially identify the impact of chronic diseases such as diabetes on fatigue. Assessing the different components of fatigue is important for clinicians in improving disease management and outcomes. Further investigations are needed to confirm these observations in specific cohorts with other comorbidities.

Identifying potential therapeutic targets of mulberry leaf extract for the treatment of type 2 diabetes: a TMT-based quantitative proteomic analysis

BACKGROUND

Mulberry (Morus alba L.) leaf, as a medicinal and food homologous traditional Chinese medicine, has a clear therapeutic effect on type 2 diabetes mellitus (T2DM), yet its underlying mechanisms have not been totally clarified. The study aimed to explore the mechanism of mulberry leaf in the treatment of T2DM through tandem mass tag (TMT)-based quantitative proteomics analysis of skeletal muscle.

METHODS

The anti-diabetic activity of mulberry leaf extract (MLE) was evaluated by using streptozotocin-induced diabetic rats at a dose of 4.0 g crude drug /kg p.o. daily for 8 weeks. Fasting blood glucose, body weight, food and water intake were monitored at specific intervals, and oral glucose tolerance test and insulin tolerance test were conducted at the 7th and 8th week respectively. At the end of the experiment, levels of glycated hemoglobin A1c, insulin, free fat acid, leptin, adiponectin, total cholesterol, triglyceride, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were assessed and the pathological changes of rat skeletal muscle were observed by HE staining. TMT-based quantitative proteomic analysis of skeletal muscle and bioinformatics analysis were performed and differentially expressed proteins (DEPs) were validated by western blot. The interactions between the components of MLE and DEPs were further assessed using molecular docking.

RESULTS

After 8 weeks of MLE intervention, the clinical indications of T2DM such as body weight, food and water intake of rats were improved to a certain extent, while insulin sensitivity was increased and glycemic control was improved. Serum lipid profiles were significantly reduced, and the skeletal muscle fiber gap and atrophy were alleviated. Proteomic analysis of skeletal muscle showed that MLE treatment reversed 19 DEPs in T2DM rats, regulated cholesterol metabolism, fat digestion and absorption, vitamin digestion and absorption and ferroptosis signaling pathways. Key differential proteins Apolipoprotein A-1 (ApoA1) and ApoA4 were successfully validated by western blot and exhibited strong binding activity to the MLE's ingredients.

CONCLUSIONS

This study first provided skeletal muscle proteomic changes in T2DM rats before and after MLE treatment, which may help us understand the molecular mechanisms, and provide a foundation for developing potential therapeutic targets of anti-T2DM of MLE.