Fatigue symptoms relate to systemic inflammation in patients with type 2 diabetes

Abstract

Fatigue is frequent in patients with diabetes and this symptom appears to be more prominent in type 2 rather than type 1 diabetic subjects. Chronic inflammation represents one characteristic of type 2 diabetes that may contribute to fatigue symptoms. This possibility was assessed in a sample of 20 type 2 diabetic patients relatively to a group of 20 type 1 diabetic subjects. Specific dimensions of fatigue, including general fatigue, physical fatigue, reduced activity, mental fatigue and reduced motivation, were assessed using the Multidimensional-Fatigue-Inventory (MFI). Biological assays comprised the measurement of serum inflammatory markers [high-sensitive C-reactive-protein (hsCRP), high-sensitive interleukin-6 (hsIL-6), high-sensitive tumor-necrosis-factor-α (hsTNF-α) and neopterin]. Clinical parameters including indexes of adiposity were collected. In comparison to type 1 diabetic subjects, patients with type 2 diabetes exhibited higher fatigue scores, notably in the dimensions of general fatigue, physical fatigue and reduced activity, together with greater levels of inflammatory markers that correlated with indexes of adiposity. Regression analyses controlling for diabetes duration, insulin treatment status, glycemic control and fasting status, indicated that levels of inflammatory markers, in particular hsIL-6, hsCRP and neopterin, were associated with MFI fatigue dimensions in type 2 diabetic patients. Mediation analyses revealed that adiposity did not significantly account for the relationship of inflammatory markers with fatigue scores albeit coefficient regressions decreased somewhat when this variable was controlled for in regression models. These findings indicate that systemic low-grade inflammation relates to fatigue symptoms in patients with type 2 diabetes and suggest the involvement of inflammatory processes in the pathophysiology of diabetes-related fatigue.

Aerobic exercises alleviate symptoms of fatigue related to inflammatory cytokines in obese patients with type 2 diabetes.

“…This symptom not only impacts the patient's quality of life and compliance to treatment, but it is also associated with an increased risk of diabetic complications 25 . Significant associations were found between fatigue symptom dimensions and circulating levels of inflammatory markers in obese patients with type 2 diabetes, suggesting the involvement of inflammatory processes in the development of type 2 diabetes-related fatigue 26 .…”

“…Patients with type 2 diabetes commonly experience fatigue, which may be incapacitating and adversely affect self-care regimens 1 which increases the risk of other diabetic complication along with its adverse affection on diabetic patient quality of life 2,3 . Most people with insulin-resistant type 2 diabetes are either overweight or obese 4 .…”

Fatigue in Adults with Type 2 Diabetes—An Overview of Current Understanding and Management Approaches

“…3,10 Fritschi and Quinn recently provided a detailed review of the correlates of fatigue in diabetes, including conflicting findings regarding the relationship between fatigue and glycemic control. 8 Type 2 diabetes is a disorder associated with chronic low-grade inflammation.…”

“…8 Type 2 diabetes is a disorder associated with chronic low-grade inflammation. 17,18 Type 2 diabetes and insulin resistance, especially among obese patients, were linked to an increased production of cytokines and CRP were associated with high fatigue levels 10,11,19,20 and depression and sleep disturbances in a variety of diseases. [21][22][23][24] There is a considerable gap in the literature, however, about the treatment of fatigue secondary to type 2 diabetes.…”

Fatigue in Adults with Type 2 Diabetes – An Overview of Current Understanding and Management Approaches

“…3,7,10,11 Fatigue in type 2 diabetes may be is associated with higher body mass index (BMI), 1,7,12 the presence of co-morbid conditions, 7,13 depression, 7 physical inactivity, 1,7,14 sleep disturbances 1,15,16 and elevated cytokines. 3 10,11,19,20 and depression and sleep disturbances in a variety of diseases. [21][22][23][24] There is a considerable gap in the literature, however, about the treatment of fatigue secondary to type 2 diabetes.…”