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

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


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

Methods: 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)].

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, 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).

Conclusions: 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.

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

MeSH terms

  • Biomarkers / blood
  • Blood Glucose / metabolism
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / complications*
  • Fatigue / diagnosis
  • Fatigue / epidemiology
  • Fatigue / etiology*
  • Female
  • Glycated Hemoglobin / metabolism*
  • Humans
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Prospective Studies
  • Severity of Illness Index
  • Surveys and Questionnaires


  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A