Objective-Fatigue is a common and distressing complaint among people with diabetes, and likely to hinder the ability to perform daily diabetes self-management tasks. A review of the literature about diabetes-related fatigue was conducted with an eye toward creating a framework for beginning to conduct more focused studies on this subject.Methods-A literature search containing the terms diabetes, fatigue, tiredness, and symptoms was conducted to search for literature that addressed diabetes-related fatigue.Results-Diabetes presents many potential pathways for fatigue, but focused studies on this symptom are rare. Furthermore, research on diabetes-related fatigue is limited by fatigue's nonspecific symptoms and because fatigue researchers have yet to agree on standardized definition, measurement or diagnostic criteria. Additionally, few diabetes randomized clinical trials included measurement of patient-reported outcomes, such as symptoms or health-related quality of life in their study designs, though one that did provided some the meaningful finding that symptom-focused education improved self-management practices, Hb A1c levels, quality of life and symptom distress.Conclusion-There is a need to standardized definition, measurement and diagnostic criteria of fatigue in diabetes. We present a model that can guide focused studies on fatigue in diabetes. The model capitalizes on the multidimensional phenomena (physiological, psychological, and lifestyle) associated with fatigue in diabetes.

Purpose The purpose of this study was to explore the relationship between fatigue and physiological, psychological, and lifestyle phenomena in women with type 2 diabetes (T2DM) in order to establish the magnitude and correlates of fatigue in women with T2DM and explore the interrelationships between fatigue and specific diabetes-related factors that may be associated with increased levels of fatigue. These factors included physiological factors (glucose control, diabetes symptoms), psychological factors (diabetes emotional distress, depressive symptoms in general), and lifestyle factors (body mass index, physical activity). Methods A cross-sectional, descriptive design was used. Women who reported conditions known to cause fatigue were excluded. Physiological measures included fasting blood glucose (FBG), hemoglobin A1C (A1C), glucose variability, and body mass index (BMI). Women completed questionnaires about health, fatigue levels, diabetes symptoms, diabetes emotional distress, depressive symptoms, physical activity, and current diabetes self-care practices. A subset of the women wore a Medtronic Gold CGM sensor for 3 days for assessment of glucose variability. Results Eighty-three women aged 40 to 65 years with T2DM completed the study. Fatigue was significantly related to diabetes symptoms, diabetes emotional distress, depressive symptoms, higher BMI, and reduced physical activity. There was no relationship between fatigue and FBG or A1C. The strongest explanatory factors for fatigue were diabetes symptoms, depressive symptoms, and BMI, which accounted for 48% of the variance in fatigue scores. Glucose variability was not significantly associated with fatigue in these women. Conclusions Fatigue is a persistent clinical complaint among women with T2DM and may signal the presence of physiological, psychological, and lifestyle-related phenomena that could undermine diabetes health outcomes.

The aim of this study was to determine the effect of an 8-week empowerment intervention on sedentary behavior, physical activity, and psychological health in Korean older adults with hypertension. Using a quasi-experimental design, older adults participated in either an experimental group (n = 27) or control group (n = 21). The experimental group received an empowerment intervention including lifestyle modification education, group discussion, and exercise training for 8 weeks, and the control group received standard hypertension education. After 8 weeks, participants in the experimental group had significantly decreased sedentary behavior, increased physical activity, increased self-efficacy for physical activity, and increased perceived health (p < 0.05). However, no significant group difference was found for depression. Findings from this study suggest that empowerment interventions may be more effective than standard education in decreasing sedentary behavior and increasing physical activity, self-efficacy for physical activity, and perceived health in Korean older adults with hypertension.

Aims and objectives To explore and synthesize current research to assess the state of science about the relationship between sleep disturbance and glycemic control in adults with type 2 diabetes (T2DM). Background Sleep disturbance is suggested a risk factor for T2DM. Diabetes alone is a leading cause of death, but when coupled with sleep disturbance poses additional health risks. However, little is known about the relationship between sleep disturbance and glycemic control in people with overt diabetes. Design An integrative review. Methods Whittemore and Knafl's methodology guided this integrative review. Original studies published before Oct. 2016 were identified through systematic searches of seven databases using terms: diabet*; sleep or insomnia; glycem* or glucose or A1C or HbA1c or sugar; and their combinations. The matrix and narrative synthesis were employed to organize and synthesize the findings, respectively. The Crowe Critical Appraisal Tool was used to evaluate the study quality. Results A total of 26 studies were identified; 17 of which reported significant relationships between sleep measures and glycemic control. In 13 studies sleep duration was associated with glycemic control in both linear (n=2) and nonlinear (n=3) relationships, however 8 studies reported no significant relationships. Sleep quality was significantly related to glycemic control in 14 of 22 studies. Nine studies found no relationship between any measure of sleep and glycemic control. Conclusions There is strong evidence supporting the relationship between sleep quality and glycemic control but further examination of the relationship between sleep duration and glycemic control is warranted. Sleep disturbance, particularly impaired sleep quality, could potentially influence glycemic control in adults with T2DM. Relevance to clinical practice Nurses who treat patients with diabetes should include assessment of sleep, education for healthy sleep, and referral for treatment of sleep disturbance in order to maximize the potential for achieving good glycemic control.

Aim The purpose of this study was to examine the mediating influence of diabetes health characteristics (diabetes distress, depression symptoms and diabetes symptoms) on the relationship between glucose control and fatigue in adults with type 2 diabetes. Background In patients with type 2 diabetes, fatigue is common and can affect diabetes self-management behaviors. Although long thought to result from hyperglycemia, little evidence supports a relationship between fatigue and glucose control. Design A cross-sectional, descriptive study design was used. Method Data were combined from two studies conducted at a large urban university in the Midwestern United States, resulting in a total sample of 155 urban-dwelling adults with type 2 diabetes. Data were collected over the course of 6 days from 2013 - March 2014. Fatigue and related biological and psychological phenomena were measured to perform path analyses using structural equation modeling methods. The STATA software was used to analyze the data. Findings In patients with A1C less than or equal to 7%, fatigue was related to diabetes distress and diabetes symptoms, but not to A1C directly or indirectly. In the group with A1C greater than 7%, fatigue was indirectly related to A1C; this relationship was mediated through diabetes symptoms, depression and diabetes distress. Conclusion Our findings suggest that fatigue is indirectly related to glucose control, but only in patients who have elevated A1C levels. In those with adequate glucose control, fatigue is mainly influenced by the presence of diabetes symptoms and distress. In both groups, the number and severity of diabetes symptoms were the strongest predictors of fatigue, regardless of blood glucose control.

This program may be effective for elderly stroke patients and their caregivers.

The effects of exercise and sedentary behavior have different physiologic responses, which have yet to be fully explained. Time spent in sedentary behavior has been associated with glucose intolerance in adults at risk for type 2 diabetes, but these data come largely from cross-sectional studies and do not explore this relationship in adults with diabetes. The specific aim of this study was to examine the relationship between time spent in sedentary behavior and glucose levels in adults with diagnosed type 2 diabetes over 3 to 5 days. Methods: Using continuous and concurrent data gathered from wrist accelerometry and a continuous glucose monitoring system (CGMS), we conducted a longitudinal, descriptive study involving 86 patients with type 2 diabetes. Results: More time spent in sedentary behavior was predictive of significant increases in time spent in hyperglycemia (B = 0.12, p < 0.05). Conclusions: These findings highlight the entwined relationship between time spent sedentary and time spent in hyperglycemia identified through our use of objective, continuous data collection methods for both sedentary behavior and glucose levels across multiple days (Actiwatch, CGMS). For patients with type 2 diabetes, these findings offer possibilities for the development of individualized interventions aimed at decreasing the amount of time spent in hyperglycemia by reducing sedentary time.

This randomized trial proposed to determine if there were differences in calf muscle StO2 parameters in patients before and after 12 weeks of a traditional walking or walking-with-poles exercise program. Data were collected on 85 patients who were randomized to a traditional walking program (n = 40) or walking-with-poles program (n = 45) of exercise training. Patients walked for 3 times weekly for 12 weeks. Seventy-one patients completed both the baseline and the 12-week follow-up progressive treadmill tests (n = 36 traditional walking and n = 35 walking-with-poles). Using the near-infrared spectroscopy measures, StO2 was measured prior to, during, and after exercise. At baseline, calf muscle oxygenation decreased from 56 ± 17% prior to the treadmill test to 16 ± 18% at peak exercise. The time elapsed prior to reaching nadir StO2 values increased more in the traditional walking group when compared to the walking-with-poles group. Likewise, absolute walking time increased more in the traditional walking group than in the walking-with-poles group. Tissue oxygenation decline during treadmill testing was less for patients assigned to a 12-week traditional walking program when compared to those assigned to a 12-week walking-with-poles program. In conclusion, the 12-week traditional walking program was superior to walking-with-poles in improving tissue deoxygenation in patients with PAD.