Neuropathy primary driver behind higher fatigue in adults with diabetes
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SAN DIEGO — Adults with diabetes experience more fatigue compared with those without diabetes, with diabetic neuropathy being the primary driver for increased fatigue, according to a speaker.
In findings from a study presented at the AACE Annual Scientific and Clinical Conference, researchers used the Norfolk Quality of Life (QOL) – Fatigue tool to measure the cognitive, physical and emotional aspects of fatigue of people with diabetes compared with healthy controls without diabetes.
“We think the Norfolk QOL – Fatigue questionnaire has the potential to identify the impact of chronic diseases such as diabetes and neuropathy on the development of different components of fatigue,” Carolina M. Casellini, MD, assistant professor at the Strelitz Diabetes Center at Eastern Virginia Medical School in Norfolk, Virginia, said during a presentation. “Assessing the different components is especially relevant to clinicians caring for subjects with diabetes as fatigue can interfere with numerous factors affecting diabetes control and diabetes outcomes.”
Casellini and colleagues conducted a cross-sectional survey of adults aged 18 to 79 years living in the Hampton Roads, Virginia, region from 2018 to 2022. Participants included 400 adults with type 1 or type 2 diabetes and 140 healthy controls without diabetes. The Norfolk QOL – Fatigue tool was conducted in-person at the Strelitz Diabetes Center before the COVID-19 pandemic and virtually after the pandemic started. The questionnaire includes 35 items in five domains: subjective fatigue; physical and cognitive problems; depression; reduced activities; and activities of daily living. Respondents scored each item on a scale of zero to four, with a higher score indicating greater fatigue. Demographics including height, weight, BMI, waist circumference and duration of diabetes were self-reported. Participants with diabetes also completed the Norfolk QOL – Diabetic Neuropathy questionnaire to assess the impact of neuropathy on fatigue.
The diabetes group had a higher overall fatigue score in the questionnaire compared with the control group (mean score, 52.83 vs. 29.11; P < .0001) as well as higher scores in all five domains of the fatigue questionnaire. Of those with diabetes, 311 had neuropathy and 89 did not have neuropathy. Participants with diabetes and neuropathy had a higher overall fatigue score (mean score, 59.72 vs. 27.83; P < .0001) and a higher score in all five individual domains compared with those with diabetes and no presence of neuropathy.
Within the control group, women had a higher fatigue score than men. However, no differences between men and women were observed within the diabetes cohort. There were no differences in fatigue score between racial-ethnic groups.
When evaluating other demographics, younger participants were more likely to have a worse fatigue score compared with older adults. No associations were observed for weight, BMI or duration of diabetes.
“There are several theories around this,” Casellini said of the association between higher fatigue and younger adults. “Fatigue symptoms may be perceived as less severe by individuals who experience them for a longer time, and there may be potential generational differences in everyday responsibilities and life stressors.”
Casellini said more studies are needed to assess fatigue in cohorts with other comorbidities and to evaluate the utility of the tool against other tools for evaluating fatigue.
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Casellini CM, et al. Utilizing a quality of life tool to examine the presence of fatigue in subjects with diabetes mellitus. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; May 12-14, 2022; San Diego.
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