Aims and objectives To synthesise empirical studies on factors related to fatigue and its impact on diabetes self‐management (DSM) and quality of life (QOL) in adults with type 2 diabetes mellitus (T2DM). Background Fatigue is commonly reported in people with T2DM, a chronic condition that is highly prevalent worldwide. However, a holistic understanding of the consequences and factors related to fatigue in adults with T2DM is not well synthesised. Design This integrative review used Whittemore and Knafl's methodology and was reported according to the Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and checklist. Methods The theory of unpleasant symptoms (TOUS) was used as a conceptual model to guide the review. The PubMed, PsychINFO and CINAHL databases were searched to identify studies that recruited adults with T2DM, were peer‐reviewed, written in English and investigated fatigue as a primary or secondary outcome. Two investigators independently appraised the quality of the studies and extracted the data. Results Twenty‐nine articles met the inclusion criteria: 23 observational studies, two randomised controlled trials, one quasi‐experimental study and three qualitative studies. All articles were of high quality. Physiological (e.g. T2DM duration, complications and inflammatory biomarkers), psychological (e.g. diabetes distress, depression and sleep quality) and situational factors (e.g. race/ethnicity, education and social support) were related to fatigue. Studies reported fatigue as a barrier to physical activity, healthy eating behaviours and the physical aspect of QOL. Conclusions Multiple factors are related to fatigue in adults with T2DM. Gaps in the literature include the multiple dimensions of fatigue, the effectiveness of interventions to alleviate fatigue and fatigue experiences in under‐represented populations. Relevance to clinical practice This integrative review supports the complex origin of fatigue and its impact on adults with T2DM. Nurses should evaluate modifiable factors related to fatigue and provide support to help improve DSM and QOL in this population.

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Objective: Since 2010, more than 527,000 refugees have resettled in the United States (US), most from Asia, fleeing war, violence, and persecution. However, there is little research that integrates findings about health among Southeast Asian refugees (SEAR). Design:We conducted an integrative review of studies that examined health status, risk factors, and barriers to healthcare access among SEAR in the US. We synthesized findings of studies published from 1980, when the Refugee Act was enacted, to 2022 using five databases. We reviewed 20 articles and data were extracted into a table for synthesis.Results: Participants were from Cambodia, Vietnam, Laos, Burma and the Thailand-Myanmar border. Hypertension (12%-64%), hypercholesterolemia (37%-39%), diabetes (0.6%-27%), heart disease (7%), bone and muscle problems (23%-50%), and chronic pain (8%-51%) were most common physical health problems; and PTSD (45%-86%) and depression (20%-80%) were the most common mental health problems.Trauma, resettlement stress, lack of community or religious engagement were associated with mental health problems. Language differences, transportation, and lack of health insurance were the most significant obstacles to receiving healthcare. Conclusion: SEAR experienced worse physical and mental health than the general US population. Different patterns of disease were identified depending on gender, time settled in the US, and ethnic group. Qualitative and longitudinal studies will elucidate refugees' experience and should guide interventions. K E Y W O R D S access to healthcare, ethnic minority, health disparity, health status, refugees 1 BACKGROUND Nearly 89.3 million people were forcibly displaced from their homes worldwide in 2021, and an additional 10 million were displaced in the first 5 months of 2022. Over 27 million currently displaced persons have been designated as refugees (The Office of the United Nations High Commissioner for Refugees (UNHCR), 2022), meaning that they are people who have fled war, violence, conflict, or persecution and have crossed an international border to find safety in another country (United Nations, n.d.). The number of refugees more than doubled from 2010 to 2020 and continues to rise due to unstable political situations in many countries, with more refugees in the world than ever in history. Many refugees have experienced considerable trauma in their home country and during migration (Sangalang et al., 2019). The United States (US) accepts the most refugees and has had the largest resettlement program in the world since the 1970s (UNHCR, 2022). In the past 45 years about 3,450,000 refugees from throughout the world resettled in the US; 600,900 refugees arrived in the US 324

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Introduction: People with type 2 diabetes mellitus (T2DM) experience various symptoms that are likely to worsen mental and physical well-being. Fatigue is one of the most prevalent and disturbing symptoms for adults with T2DM. This literature review 1) examined demographic, physiologic, and psychosocial factors related to fatigue, and 2) explored the associations among fatigue, diabetes self-management and quality of life (QoL) in adults with T2DM. Methods: We searched PubMed, PsycINFO, and CINAHL electronic databases for research articles that included a sample of adults with T2DM; were peer-reviewed, written in English; and investigated fatigue as a primary or secondary outcome. Two investigators independently appraised the quality of the studies and extracted the data. Results: Twenty-two articles met the inclusion criteria (representing n = 15,610 people): 17 observational studies, 2 randomized controlled trials, 1 quasi-experimental study, and 2 qualitative studies. All were of high quality. Most studies were conducted in the U.S. (n = 13); others were conducted in 9 other countries. Non-Hispanic White and Black were the most studied. Fatigue was measured using the Multidimensional Fatigue Inventory (n = 6) and 8 other measures. Demographic (e.g., age, sex, education, social support), physiological (e.g., T2DM duration, complications, inflammatory biomarkers), and psychological factors (e.g., diabetes distress, depression, sleep quality) were related to fatigue in adults with T2DM. Most studies examined physiological factors related to fatigue using a cross-sectional design. Fatigue was negatively associated with both diabetes self-management and QoL. Conclusion: Research demonstrates significant relationships between fatigue and self-management and QoL in adults with T2DM. Gaps in the literature include the trajectory of fatigue over time, effects of interventions (e.g., sleep interventions) to alleviate fatigue, and unique experiences of fatigue in under-represented populations. Disclosure H. Kuo: None. Y. Huang: None. A.A. Garcia: None.