| dc.description.abstract | Characterized by difficulty in initiating and sustaining mental and physical tasks, fatigue is a common complaint among individuals with diabetes. Unfortunately, fatigue is mostly neglected in those with diabetes because it is often overshadowed by more pronounced complications like neuropathy, retinopathy, and nephropathy. However, fatigue may undermine these patients' essential efforts to self-manage their disease. Fatigue-related difficulties may lead to decreased physical activity levels that often result in reduced cardiovascular fitness. Those with type 2 diabetes often experience the additional challenges of obesity, depression, and impaired glycemic control, each of which may be associated with fatigue. Although complaints of fatigue are common in people with type 2 diabetes, no research has been done investigating its presence or severity of this problem in people with diabetes. Moreover, little research has attempted to examine its causative factors or impact on function or quality of life in this population. Qualitative research has been a primary means of investigating fatigue in other medical conditions. To develop a more complete picture of fatigue and its related factors, there is a need to incorporate both quantitative and qualitative research methods. The overall purpose of this dissertation was to investigate fatigue in people with type 2 diabetes. The specific aims were to: 1) test the presence and severity of fatigue, 2) investigate contributing factors leading to fatigue, and 3) investigate the influence of fatigue on function and quality of life in people with type 2 diabetes. Although fatigue is a common complaint among individuals with type 2 diabetes, no studies have attempted to quantify it. To begin Chapter 2 aimed to test the presence and severity of fatigue in people with type 2 diabetes as compared to a non-diabetic group. Three fatigue surveys were completed by 37 individuals with and 33 individuals without diabetes. Results indicated that people with type 2 diabetes scored higher on all three fatigue assessment scales. Higher levels of fatigue were noted in people with type 2 diabetes as compared to healthy age matched controls; however the cause and impact of these changes were not known. Fatigue can result from various physiological and psychological factors occurring from diabetes. Additionally, since fatigue is such a complex phenomenon it becomes very challenging to study. Chapter 3 intended to investigate the contributing factors of fatigue in individuals with type 2 diabetes by using a mixed methods design using both quantitative and qualitative research methods. Forty eight individuals with type 2 diabetes participated in the study. A subsample of 10 participants participated in the qualitative section of the study. Results of the quantitative section revealed that poor sleep quality, pain and high BMI are the independent predictors of fatigue. Interview findings further supported the quantitative results by identifying fatigue as multidimensional in nature. Participants expressed sleep problems, extra body weight, pain, high/low blood glucose levels and depression as chief contributing factors to fatigue. Since diabetes is associated with high degree of complexity related with the medical management of the disease, this can be a great burden to many patients and can affect quality of life (QoL) of these individuals. Moreover, people with type 2 diabetes are always encouraged to engage in physical activities which could affect their functional status. Fatigue can however, further complicate this burden by compromising the QoL and functional status in individuals with type 2 diabetes. Chapter 4 investigated the relationship of fatigue with QoL and functional status in individuals with type 2 diabetes by using a mixed method design. Forty eight individuals with type 2 diabetes participated in the study. A subsample of 10 participants participated in the qualitative section of the study. Results indicated a negative relationship of fatigue with QoL and functional status. The qualitative data provided further insight into the compromised QoL and functional status and supported the findings of quantitative analysis. In summary, this body of work indicates the presence of and contributing factors to fatigue and also emphasizes the negative impact of fatigue on QoL and functional status in people with type 2 diabetes. The present study provides the first evidence uncovering the contributing factors to fatigue via a mixed method approach. Since fatigue is a very subjective experience, the use of qualitative research methods helped us in understanding what the numbers from the quantitative research methods actually mean. Similarly, the impact of fatigue on QoL and function was tested via mixed method approach. We were able to get a better understanding of the negative impact of fatigue since we were able to directly hear the voices of the participants. The results of the present work suggest that clinicians should educate their patients regarding fatigue, and interventions should focus on the contributing factors identified in the present study. | |
