Cynthia Fritschi

Fatigue in Patients with Diabetes: A Review

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 fatigues 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, although one that did provided some 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 standardize the 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.

Fatigue in Women With Type 2 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.

Physical fitness, dietary intake, and metabolic control in adolescents with type 1 diabetes

Purpose:  We examined whether physical fitness and dietary intake predicted better glycemic control and lipid profile in adolescents with type 1 diabetes mellitus (T1DM).

Cardiorespiratory Fitness and Physical Activity in Youth with Type 2 Diabetes

Objective:  The increased incidence of type 2 diabetes (T2D) among youth is hypothesized to be due, in part, to low levels of fitness and activity. Therefore, the purpose of this investigation was to examine whether cardiorespiratory fitness and physical activity are reduced in youth with T2D compared with overweight controls.

Sedentary Behavior, Physical Activity, and Psychological Health of Korean Older Adults with Hypertension: Effect of an Empowerment Intervention

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.

Total Homocysteine, Diet, and Lipid Profiles in Type 1 and Type 2 Diabetic and Nondiabetic Adolescents

Background and Research Objective: Limited research is available on the possible differences in the cardiovascular risk factors of total homocysteine (tHcy), dietary energy, and lipids among adolescents with type 1 diabetes mellitus (DM), type 2 DM, or healthy controls. This studys primary aim was to compare the dietary energy and the intake of macronutrients and micronutrients of folate, and vitamins B6 and B12, as well as lipids and tHcy for adolescents with type 1 DM, type 2 DM, and healthy non-DM controls. Subjects and Methods: This secondary analysis of the merging of 2 datasets included the following adolescents: 50 with type 1 DM, 14 with type 2 DM, and 53 controls. Mean ages for those with type 1 versus type 2 DM were 15.2 ± 1.9 versus 16.1 ± 1.9 years, respectively. Mean age for the controls was 16.5 ± 1.0 years. Variables included fasting tHcy and lipids, and 24-hour dietary recalls for macronutrients and micronutrients. Hemoglobin A1c was obtained for those with DM. Statistical analyses included one-way analyses of variance, Pearson correlations, and stepwise regression. Results and Conclusions: Adolescents with type 1 DM had the lowest tHcy values (P <.05), which were reflective of the limited extant research with this population. Lipid profiles and dietary energy did not differ significantly among the 3 groups. Hemoglobin A1c was related to total cholesterol and triglycerides in those with type 1 DM, confirming the importance of promoting better metabolic control in lipid management for these youth. Future research should continue to explore the validity of tHcy and lipids as predictors of CV risks for youth with type 1 and type 2 DM.

Nurse-led empowerment strategies for hypertensive patients with metabolic syndrome

Purpose: The aim of this study was to compare the effect of a nurse-led empowerment-based intervention to that of standard care on metabolic syndrome risk factors, self-management behaviors, and walking activity in Korean hypertensive patients. Methods: Using a quasi-experimental design, patients participated in an experimental group (N = 30) or control group (N = 22). The experimental group received eight weekly empowerment sessions, including lifestyle modification education, empowerment group discussions, and exercise training, while the control group received standard hypertension care. Results: The experimental group had significantly improved metabolic syndrome symptoms and prevalence, empowerment scores, self-management behaviors, and walking (all p < 0.05). Conclusions: Findings from this study suggest that, in Korean hypertensive patients, empowerment interventions are more effective than standard care in improving metabolic syndrome risk factors, empowerment, self-management behaviors, and walking.

The effects of smoking status on walking ability and health-related quality of life in patients with peripheral arterial disease.

BACKGROUND Smoking is a leading risk factor for peripheral arterial disease (PAD), yet little is known about the interrelationships among smoking status, walking endurance, calf muscle tissue oxygenation, and quality of life in patients with PAD. OBJECTIVE The aim of this study was to explore the differences in factors associated with walking endurance including walk distance, perceived walking ability, measures of skeletal muscle tissue oxygenation (StO2), claudication pain, peak oxygen consumption per unit time, and quality of life in smokers versus nonsmokers. METHODS A total of 105 patients with PAD performed progressive, symptom-limited treadmill test. Ankle-brachial index was measured at baseline. Calf muscle tissue oxygenation measures were obtained during testing. The RAND Short Form-36 and Walking Impairment Questionnaire were used to measure health-related quality of life (HR-QoL). RESULTS In the total sample (36 current smokers, 69 nonsmokers), smokers had steeper declines in StO2 from baseline to 2 minutes (42.3% vs 33%, P = .05) and shorter distance walked to onset of claudication pain (142.6 vs 247.7 m) than did nonsmokers (P < .0125), despite having no differences in ankle-brachial index, peak oxygen consumption per unit time, or any momentary measure of StO2 during walking. Smokers reported significantly lower HR-QoL on the Short Form-36 in several domains but no differences in the Walking Impairment Questionnaire measures. The smokers were younger than the nonsmokers; however, when age was entered as a covariate in the analyses, the results remained unchanged. CONCLUSIONS These findings suggest that smokers have lower HR-QoL than do nonsmokers with PAD and that smoking confers risks for disrupted tissue oxygenation above those seen in patients who do not smoke.

Type 2 diabetes in youth: A phenotype of poor cardiorespiratory fitness and low physical activity

OBJECTIVE The increased incidence of obesity and type 2 diabetes (T2D) among youth has prompted the development of guidelines for healthy cardiorespiratory fitness (CRF) and physical activity (PA) levels in the pediatric population. It is unclear whether youth with T2D meet these guidelines as previous research has not included type 2 diabetics. Therefore, the purpose of this investigation was to examine CRF and PA in youth with T2D and compare these results with recently published normative data for CRF and guidelines for PA in youth. METHODS. Forty adolescents (17 males and 23 females) with T2D were assessed for moderate-to-vigorous PA via the 7-day PA recall. CRF was determined by a progressive cycle ergometer test and indirect calorimetry. PA levels were compared with recently published guidelines for youth of 60 minutes per day, and CRF data were compared with age- and sex-adjusted normative values from the National Health and Nutrition Examination Survey 1999-2002. Results. Only 17.6% (3/17) of boys and 21.7% (5/23) of girls met PA guidelines, while none of the participants met criteria for healthy CRF. When compared with normative CRF data for US youth, approximately 93% of boys and 95% of girls scored below the 10th percentile. CONCLUSIONS These results suggest that youth with T2D exhibit low levels of CRF and the majority do not participate in recommended amounts of PA. Practitioners working with type 2 diabetic youth need to emphasize the importance of regular PA to increase CRF and promote cardiovascular health in an effort to decrease long-term diabetes-related complications.

The Effects of Walking or Walking-with-Poles Training on Tissue Oxygenation in Patients with Peripheral Arterial Disease

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.