Fatigue (both physical and mental) is prevalent in type I diabetes patients, with approximately 40% of patients scoring higher on fatigue scales than the general population. A recent study published in the Lancet Diabetes-endocrinology evaluates the efficacy cognitive behavioral therapy (CBT) to reduce fatigue in type I diabetes patients.
Several studies have shown that cognitive behavioral therapy (CBT) can help ameliorate fatigue symptoms. CBT is based on a model which assumes that fatigue is triggered by disease-specific elements, such as hyperglycemia in the case of type I diabetes, and maintained by cognitive-behavioral elements. Based on these assumptions, a diabetes-specific CBT intervention was developed and delivered as a combination of face-to-face and web-based sessions. Previously, no study had addressed CBT intervention for fatigue in type I diabetes patients. Parameters such as glycemic control and functional impairment were also evaluated.
Between 2014-2016, 120 patients from medical and university centers in the Netherlands were randomly assigned to a treatment (n=60) or waiting list control (n=60) group. Eligible participants included patients, aged 18-70, who had been diagnosed with type 1 diabetes for at least 1 year, were able to speak/read/write Dutch, scored 35 or higher on the fatigue scale (ranges from 8-56) and had chronic fatigue defined as lasting 6 months or more. Patients with severe diabetes complications such as renal failure, blindness and heart failure were ineligible. All study participants were provided with study information and voluntarily signed an informed consent form.
The treatment group received 5 months of CBT delivered by clinical psychologists trained in fatigue therapy for type 1 diabetes (named Dia-Fit). Patients assigned to the control group received therapy following the 5-month study period.
The outcome of therapy was assessed with a fatigue severity scale checklist which included eight questions scored from 1-7. A total score of 35 or higher represents severe fatigue.
Following the 5-month treatment period, patients from the CBT group had significantly lower fatigue scores compared to control group (mean difference 13·8, 95% CI 10.0-17.5; p<0·0001). In addition, CBT was associated with significantly lower scores for functional impairment (mean difference 513, 95% CI 340-686, p<0·0001). 77% of patients in the CBT group reported significant improvement in fatigue symptoms and overall functioning as compared to 25% in the control group awaiting CBT treatment. No significant differences were identified in glycemic control between groups. During a 6-month follow-up period, most patients still reported improvement in fatigue symptoms (61% as compared to 77% immediately following treatment), indicating that CBT treatment has a long-lasting effect.
The authors note that researchers and patient participants were unmasked to treatment group, which may have introduced bias. Additional limitations include the relatively small sample size, eligibility criteria excluding patients with diabetes complications and inability to assess patient compliance with CBT sessions. Further studies with modified eligibility criteria are needed.
Taken together, the results suggest that CBT is a safe and promising treatment for reducing fatigue symptoms in type I diabetes patients.
Written By: Bella Groisman, PhD