title: Severe fatigue in type 1 diabetes: Exploring its course, predictors and relationship with HbA1cin a prospective study.
abstract: To prospectively identify the course of severe fatigue, its predictors and the relationship with HbA1cin patients with type 1 diabetes.
  
  
  
  214 adult patients completed questionnaires on fatigue severity and fatigue-related factors at baseline. HbA1cwas retrieved from medical records. After 43months, fatigue severity and HbA1cwere 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 HbA1cwas 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, HbA1cat 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. HbA1cand 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.
authors.affiliation: Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Juliane.Menting@radboudumc.nl.
authors.forename: Juliane
authors.initials: J
authors.lastname: Menting
authors.affiliation: Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nikolaus
authors.affiliation: Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
authors.forename: William M
authors.initials: WM
authors.lastname: van der Veld
authors.affiliation: Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Martine M
authors.initials: MM
authors.lastname: Goedendorp
authors.affiliation: Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Cees J
authors.initials: CJ
authors.lastname: Tack
authors.affiliation: 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.
authors.forename: Hans
authors.initials: H
authors.lastname: Knoop
mesh_terms: D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: HbA(1c); Persistent fatigue; Predictors of fatigue; Prospective design; Type 1 diabetes